January 8, 2025
Medicare Rule Changes for Physical Therapists Effective January 1, 2025
- by Shannon DeConda, Partner, Founder and President of NAMAS
As we step into 2025, Medicare has introduced updates that bring more flexibility and reduced administrative burdens for physical therapists (PTs), occupational therapists (OTs), and their assistants. These changes aim to improve patient access to therapy services while addressing long-standing concerns in rural and underserved areas. Here’s a breakdown of the key updates and what they mean for your practice.
General Supervision Policy for PTAs and OTAs in Private Practice
What’s Changing:
Starting January 1, 2025, physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) in private practice settings will be allowed to work under general supervision instead of direct supervision. This aligns the supervision requirements for private practice PTs and OTs with those working in institutional providers.
What It Means for You:
- Greater Flexibility: This policy gives PTs and OTs in private practice more leeway to structure care delivery, particularly in areas where staffing challenges exist.
- Improved Access to Care: Beneficiaries in rural and underserved regions stand to benefit as therapy services can be delivered with less restrictive supervision.
- Regulatory Alignment: The change aligns private practice supervision policies with those of institutional providers, simplifying compliance for PTs and OTs who operate across different settings.
Action Items:
- Review your practice’s supervision protocols to align with the new rule.
- Educate PTAs and OTAs on the changes to ensure they understand their responsibilities under general supervision.
Certification of Therapy Plans of Treatment
What’s Changing:
Medicare has finalized amendments to the certification requirements for therapy plans of treatment, significantly reducing administrative burdens:
- Signature Requirement Exception: If a written order or referral from the patient’s physician or non-physician practitioner (NPP) is on file, the therapist-established treatment plan does not need a separate physician/NPP signature for initial certification. The therapist must document evidence that the treatment plan was transmitted to the physician/NPP within 30 days of the initial evaluation.
- No Timeline Restriction on Modifications: CMS did not adopt a specific timeframe within which a physician/NPP could modify the treatment plan. Payment will still be made for services rendered prior to any modification, provided all payment requirements are met.
What It Means for You:
- Reduced Administrative Tasks: Therapists can focus more on patient care instead of chasing signatures for initial treatment plans.
- Payment Safeguards: Therapists are assured of payment for services provided before a physician/NPP-modified treatment plan, as long as the plan was transmitted in compliance with Medicare’s requirements.
- Clear Documentation Standards: While a timeline restriction was not established, therapists should ensure robust documentation to avoid disputes over treatment plans.
Action Items:
- Update internal protocols to incorporate the new signature exception.
- Ensure treatment plans are transmitted to the physician/NPP within 30 days and maintain thorough documentation as evidence.
- Communicate with physicians and NPPs about the change to streamline collaboration.
Stay Informed and Stay Compliant Moving Forward
These CMS updates are designed to improve access and ease administrative strain for providers. Still, caution is necessary—stay informed, update your practices, and remain vigilant in maintaining compliance.
For additional guidance, visit CMS’s official website or consult with your Medicare Administrative Contractor (MAC) to ensure compliance with these new rules.
Stay informed, stay compliant, and let’s make 2025 a year of improved care and streamlined practice!
