Medicare Estimated Payments for Outpatient Therapy in 2025

On July 10, 2024, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2025 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 2025 for the more common CPT codes billed in outpatient physical, occupational and speech therapy compared to the 2024 payment rate for each CPT code. For my examples, I used the national payment averages for each CPT code. Based on the location of your clinic/organization, your payment may be higher or lower than the national average.

Keep in mind that the estimated payments may change once CMS releases the final rule in November 2024 and/or if Congress passess legislation increasing the conversion factor for CY 2025. Also, remember that some state Medicaid programs, workers compensation carriers, and commercial insurance carriers base their reimbursement on a percentage of the Medicare allowed amount for each CPT code. This means if Medicare reimbursement decreases in 2025, this could impact Medicaid, workers compensation, and commercial insurance carriers that base their payment on a percentage of the Medicare allowed amount.

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