The Centers for Medicare & Medicaid Services is close to finalizing a proposed increase in payment for physical therapist services, but PTs, PTAs, and supporters need to tell CMS to lock in the change by the Sept. 14 comment deadline.

For years, APTA and its members have advocated for meaningful changes to the way CPT codes for physical therapist services are valued.

Now, analysis from APTA staff experts of recently released data from the Centers for Medicare & Medicaid Services shows that proposed changes to how practice expenses are calculated could lead to several years of improved payment for PT services.

In reviewing data released after the proposed 2027 Medicare Physician Fee Schedule, APTA staff were able to model expected payment for practice expenses for the next eight years. Instead of the originally anticipated increase in the next two years, APTA staff modeled a 35-45% increase in practice expense relative value unit values for most commonly used codes for each code over the next eight years. For providers, that translates into a 1-3% increase each year for most commonly billed PT services.

Why Members Should Comment on the Medicare Physician Fee Schedule Proposed Rule

While the proposed changes benefit physical therapists, not all providers will expect a similar increase and many will oppose the proposal. That's why members are encouraged to voice their support by the Sept. 14 comment deadline. Members can use a template comment letter on APTA's Patient Action Center or easily draft a personalized comment letter using the APTA Regulatory Comment Tool.

How Does the Proposed Change Affect Payment for PT Services?

This increase is due to changes in the way the practice expense relative value unit is calculated. The practice expense RVU calculation includes both direct and indirect expenses. Compared to other specialties, physical therapist services have relatively low indirect costs, meaning the way CMS calculated the RVU reduced the value of physical therapy codes relative to other providers’ codes under the fee schedule. By reworking this methodology to better reflect the indirect costs for each service as opposed to the whole specialty, codes for PT services expect a moderate increase each year.

Although the ultimate impact on payment may vary over the years depending on other aspects of the fee schedule, the change in how practice expenses are calculated better reflect the costs of each physical therapy code and are a result of ongoing advocacy by APTA and its members to get payers to properly value PT services.