It’s a new year and with that, new, revised and deleted CPT codes become effective on January 1, 2026 and payment changes occur in terms of the annual Medicare therapy threshold dollar amount, use of the KX modifier for claims exceeding the therapy threshold, the targeted medical review process for claims exceeding $3000 in a calendar year and the annual Medicare Part B deductible and its impact on the annual therapy threshold dollar amount. In calendar year 2026, what is the status of outpatient therapy delivered via telehealth? For those of you who participate in the Merit-Based Incentive Payment System (MIPS) program, what changes are occurring in 2026 compared to 2025? Lastly, will Medicare reimbursement increase or decrease in calendar year 2026 compared to 2025 and might some localities see a bigger increase or decrease than others?
At the conclusion of this online course, participants will be able to:
- Discuss how time must be documented for Anthem BCBS patients receiving outpatient therapy services
- Interpret Cigna’s site of care policy for outpatient therapy services and its implications for hospital outpatient therapy departments
- Restate FY ICD-10 changes impacting outpatient therapy services
- Understand CY SLPs and their status with treating Medicare beneficiaries for outpatient speech therapy services
- Recall the 2026 conversion factor and its impact on payment under Medicare Part B therapy services
- Understand what the 2026 Medicare Part B deductible is and its impact on the annual therapy threshold
- List the 3 possible scenarios of who may pay the 2026 Medicare Part B deductible
- Name the 2 Medigap plans that cover the annual Medicare Part B deductible
- Identify the 2026 therapy threshold and the targeted medical review process for claims exceeding $3,000 in calendar year 2026
- List new, revised and/or deleted CPT codes for 2026 that may be utilized by physical or occupational therapists and/or speech-language pathologists
- Recite the current status of telehealth with traditional Medicare and major commercial insurance carriers for calendar year 2026
- Understand how the Geographic Price Cost Index for your locality impacts your Medicare payment in calendar year 2026
- Recall changes to the 2026 MIPS program compared to 2025
Rick Gawenda, P.T., graduated in 1991 with a Bachelor of Science in Physical Therapy from Wayne State University, Detroit, Michigan. Mr. Gawenda is currently the President and founder of Gawenda Seminars & Consulting, Inc. He has provided valuable education and consulting to hospitals, rehabilitation agencies, private practices, nursing homes, and his peers in the areas of CPT and ICD-10 coding, billing, documentation, reimbursement, and compliance as it pertains to outpatient therapy services as well as denial management and the appeals process for Medicare denied claims. Mr. Gawenda’s website, https://gawendaseminars.com/, provides a valuable source of information on rehabilitation rules and regulations, coding, documentation, and reimbursement.
Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is the Past President of the Section on Health Policy & Administration of the APTA as well as Past President of the Michigan Association of Medical Rehabilitation Program Administrators.
Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.
Physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists, private practice owners and practice administrators, coders and office managers at private practices, as well as directors, managers, supervisors, compliance officers, risk managers, and billers in skilled nursing facilities, hospital outpatient therapy departments, rehabilitation agencies, home health agencies doing Part B in the home, and comprehensive outpatient rehabilitation facilities.
In addition to the expertise and advice presented during this webinar conference, you’ll also receive a handout (in PDF format) that will include related reference links.
This online course has not been submitted to any state board or national organization for CEU approval. A certificate of attendance will be available upon completion of the webinar for each participant and may be adequate for credit in some states; you will need to contact your state licensing regulatory body to determine whether or not credit will be granted for this webinar conference. We provide no additional information for CEU approval.
This course was approximately 1 hour and 20 minutes (including Q&A).
There are no refunds for no shows or any other reasons once you register and payment is received. We are not responsible for organization firewalls or computer software issues that may interfere and/or prohibit your connection to the webinar portion of the presentation.
Venue system requirements:
- Microsoft Internet Explorer 7+, Mozilla Firefox 2.5+, Safari, or Chrome
- 1024 x 768 screen resolution
- Stable Internet connection, DSL or above
- Wired Internet connection; wireless is not recommended
- Flash Player 9 or higher
- Disable pop-up blockers
- Computer speakers for participants
Note: Android Smart Phones (i.e. iPhone) are not compatible.
In order to ensure a successful connection to this online course, please take a moment to conduct a system test by clicking this link: http://web.telspan.com/systemcheck
***Application Sharing does not need to be operational to view this course recording link.
*** This COURSE RECORDING and HANDOUTS is not to be distributed outside of your organization. If you have a larger organization and have multiple locations, then please contact us here for pricing.
