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

Medicare’s 8-minute rule remains very confusing not only for therapists and assistants, but also for billers, practice managers, owners of private practices, and facility directors and administrators. That is why I have created an extensive frequently asked questions (FAQs) page dedicated to the 8-minute rule. This 8-minute rule FAQ page will provide you answers to some of the most common questions I receive regarding this topic. Questions answered include, but are not limited to: To read the answers to the above questions, click HERE.

The National Correct Coding Initiative (NCCI) Edits Version 32.1 are in effect for dates of service April 1, 2026– June 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

On October 31, 2025, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2026 Medicare Physician Fee Schedule (MPFS) final rule. This final 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 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 code.

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

If you are on social media, whether Facebook, LinkedIn, X (formerly Twitter), I am sure you are seeing posts of therapists in private practices complaining about the difference in reimbursement hospital outpatient therapy departments receive compared to a private practice when providing the exact same intervention(s) and/or procedure(s). However, instead of complaining, I think private practices should use this discrepancy to their advantage. In this article, I will answer the following questions and provide valuable insight how private practices can use this discrepancy to increase their business and revenue.

This 1.5-hour online course will teach participants practical ways to improve their organization’s revenue cycle management (RCM) and bottom line.

QuestionCan therapy students treat TRICARE beneficiaries for outpatient physical, occupational and/or speech therapy services and have those services billed to the TRICARE program for reimbursement? Answer I hope you found this article helpful and informative and you now have a good understanding of therapy students treating TRICARE beneficiaries. Thank you for being a Gold Member!