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Proposed changes that could impact reimbursement for PTAs

Alert: CMS has released the 2022 Medicare Physician Fee Schedule. APTA is reviewing the rule and will soon provide a summary as well as commenting opportunities once they are open. View the rule and the fact sheet.

Beginning Jan. 1, 2022, payment for outpatient therapy services furnished by physical therapist assistants will be reimbursed at 85% of the Medicare Fee Schedule. This cut, harmful by itself, is happening in addition to other proposed cuts to the Medicare fee schedule. Patients are at risk of losing access to therapy services, just as we fight our way back from a pandemic that has increased patient need for those services and challenged the financial stability of providers.

Why It Matters

PTAs play a crucial role in the PT-PTA team and help bridge the gap in access to care. The 2022 PTA payment differential ignores that reality. Instead, the differential makes it harder for this access to be provided and threatens physical therapy businesses, particularly in rural and underserved areas. Absent action by the Centers for Medicare & Medicaid Services or Congress, the PTA payment differential will only increase the economic instability of providers who serve Medicare beneficiaries.

Our Position

CMS and Congress must act to delay the payment differential so that providers and therapy businesses can continue to recover from the impact of the pandemic. In addition, CMS and Congress must act to ensure that patient access to care in rural and underserved areas is not impeded by the differential. Finally, CMS and Congress must act to reduce burdensome Medicare requirements such as the current direct supervision requirement of PTAs in private practice.

Additional Medicare Payment Differential on Services Provided by PTAs Content

The 2022 Fee Schedule: Get Ready To Take Action

Jul 7, 2021 / News

CMS is due to release its proposal soon. Here's what you need to know — and how you can fight for physical therapy.

CMS Sheds More Light on the PTA Modifier; APTA Updates Its Quick Guide

Mar 8, 2021 / News

Expanded CMS resources include more examples. APTA revised its guide and offers additional insight.

The PTA Differential: How We Got Here, and What's Next

Feb 10, 2020 / Perspective

It can be a challenge to keep up even if you’re working hard to pay attention.

On the PTA Payment Battleground, We Are All APTA

Dec 3, 2019 / Perspective

It was not until I began working in outpatient care and seeing problems with payment, that I realized the importance of getting involved with advocacy.