On June 17, 2025, Aetna allowed direct access for physical therapy (PT) services. Aetna removed the requirement of a physician order for PT. Aetna also removed the requirement that a physician must sign the PT plan of care. Unfortunately, Aetna did not do the same for occupational therapy (OT) in June 2025. So, in 2026, what does Aetna require for outpatient OT services? Effective

Effective January 1, 2027, the American Medical Association (AMA) will delete CPT code 92507. 10 new codes are replacing 92507. The new codes are tentatively 92x0x – 92x9x. The AMA will release the 2027 CPT codes in September 2026, revealing the full 5-digits. Many pediatric practices provide speech therapy services and ABA services to a child on the same date of service. Will insurers still allow this when the new CPT codes come? 92507 and ABA Services Same Day New Speech Therapy Codes and ABA Services Same Day

Effective January 1, 2027, speech-language pathologists (SLPs) will have 10 new CPT codes. The 10 codes will be time-based and will replace 92507. In addition, The Centers for Medicare and Medicaid Services (CMS) has proposed GSLPP to be reported for pediatric patients receiving speech therapy services. CMS has proposed which codes the multiple procedure payment reduction (MPPR) policy will apply to. To Which Codes Will MPPR Apply To? To Which Codes Will MPPR Not Apply To? Can You Give Some Examples of MPPR Impacting and Not Impacting Payment?

On July 14, 2026, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2027 Medicare Physician Fee Schedule (MPFS) proposed rule. This proposed rule does have regulatory and reimbursement implications for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings. In this article, I will provide my members with the estimated payment amounts for calendar year 2027 for the more common CPT codes billed in outpatient physical, occupational and speech therapy compared to the 2026 payment rate for each CPT code. For my examples, I used the national payment averages for each CPT

On July 14, 2026, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2027 Medicare Physician Fee Schedule (MPFS) proposed rule. This proposed rule does have regulatory and reimbursement implications for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings. In this article, I will inform you of what CMS is proposing on the following topics:

The National Correct Coding Initiative (NCCI) Edits Version 32.2 are in effect for dates of service July 1, 2026– September 30, 2026. NCCI edits are used in all outpatient therapy settings for original Medicare and Medicaid beneficiaries. In addition, some Medicare Advantage plans, commercial insurers, and workers compensation programs also utilize the NCCI edits. Gawenda Seminars & Consulting has created a NCCI Edit therapy specific reference sheet for both Medicare and Medicaid. These reference sheets will inform providers when modifier 59 is required on a CPT code on the claim form. In addition, the reference sheet will inform providers what combination of

At times, it might be appropriate to have 2 disciplines of therapy treating a patient simultaneously. This is called co-treatment. Typically, we see this occur with pediatric patients. However, when you co-treat, you must bill correctly and by doing so, it most likely is not cost efficient. In this article, I will answer the following questions regarding co-treatments in the outpatient therapy setting:

Are you aware that you can use a physician order in lieu of a physician signing your initial plan of care? You didn’t? Don’t feel bad, you are not alone! Reviewers at your Medicare Administrative Contractor who are reviewing your outpatient therapy documentation are unaware as well. When Did This Change Occur? What Was The Change? What Criteria Must be Met for an Order to Serve as a POC? Which Frequency and Duration Do I Use? What Outpatient Therapy Settings Does This Change Apply To? Where Can I Obtain Additional Information on this Topic?