As reimbursement continues to decline and expenses increasing, clinics and facilities that provide outpatient speech therapy services are trying to find ways to increase their billing and thus reimbursement for speech therapy services. In this article, I will answer the following questions:

The Centers for Medicare and Medicaid (CMS) has provided updated guidance regarding Clinical Fellow (CY) speech-language pathologists (SLPs) and their ability to treat original Medicare beneficiaries for outpatient therapy services and have those services billed to the Medicare program. Here is what CMS is saying:

Private practices are facing stagnant or decreasing reimbursement, increased burdensome paperwork and authorizations from insurance carriers, and significant increases in their expenses. In addition, many private practices are now having patients with limited english proficiency (LEP) asking for interpretive services to be provided by the practice. In this article, I will answer the following questions:

On July 14, 2025, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2026 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 2026 for the more common CPT codes billed in outpatient physical, occupational and speech therapy compared to the 2025 payment rate for each CPT code. For my examples, I used the national payment averages for each CPT

On July 14, 2025, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2026 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 American Medical Association (AMA) has accepted the addition of 2 CPT codes to Appendix P. Appendix P contains CPT codes that can be reported via telehealth when using real-time interactive audio-video telecommunication. The 2 CPT codes being added are typically reported by occupational therapists (OTs) and speech-language pathologists (SLPs). In addition, these codes are primarily provided by OTs and SLPs in the pediatric setting. The 2 CPT codes being added are

The Centers for Medicare and Medicaid Services (CMS) has announced a reimbursement change for remote therapeutic monitoring (RTM). This change impacts hospital outpatient therapy departments billing for RTM. In this article, I will answer the following questions:

The National Correct Coding Initiative (NCCI) Edits Version 31.2 are in effect for dates of service July 1, 2025 – September 30, 2025. 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