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:

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 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

The Centers for Medicare and Medicaid Services has updated the Medicare Benefit Policy Manual to match the regulatory provision for the qualifications of speech-language pathologists (SLP’s) providing outpatient therapy services. This update has significant implications for the use of Clinical Fellow (CF) SLP’s. In this article, I will answer the following questions:

A therapist (employee or traveler) has left your practice or organization. After they left, you realize this therapist had 1 or more medical records they did not write a discharge report on. A question I am often asked is can another therapist that is employed by the practice or organization who never treated this patient write the discharge report based on the existing documentation in the medical record? The answer is

The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) edits Version 31.1 for original Medicare. Version 31.1 will be in effect for dates of service April 1, 2025 – June 30, 2025. To access Gawenda Seminars outpatient therapy specific NCCI edit reference sheet for original Medicare, click HERE. There is one version for private practices and a different version for nonprivate practices. Be sure to be logged into your account.

Congress has passed legislation that included a telehealth update for outpatient therapy services. This legislation extends