The big picture: The U.S. Centers for Medicare & Medicaid Services has issued its final 2022 Medicare physician fee schedule, which moves ahead with cuts to payment to nearly three dozen health care disciplines, including physical therapy, and implements a payment differential for services furnished by a PTA or occupational therapy assistant. The confirmation of the cuts was expected, given CMS' position that it is legally bound to enact both the payment reductions and the PTA differential. Also no surprise, CMS will not allow PTs to continue receiving payment for services delivered via telehealth past the public health emergency, again pointing to legislative constraints.

Among the few bright spots from CMS: increases to payment for some codes (albeit not enough to offset the cuts), more flexibility around use of the CQ modifier that indicates services delivered by a PTA, a somewhat more flexible approach to what qualifies as "direct supervision" of PTAs in a PT private practice, and acceptance of remote therapeutic monitoring/treatment management codes submitted by PTs — a reversal of CMS' position in the proposed rule.

The publication of the final rule means that all eyes now turn to Congress, where bills have been introduced that would modify the differential system and make telehealth permanent for PTs and PTAs, and where a majority of U.S. representatives have voiced support for relief from the payment cuts. Lawmakers will need to act fast, however: Without congressional action and a presidential signature, the cuts will take effect on Jan. 1, 2022. Advocates for the change can voice their support for these important issues through the APTA Patient Action Center, and can sign up for regular advocacy alerts by joining the APTA Advocacy Network.