The Floodgates Are Opening: Huge Medicare Changes Coming for PTs in 2025. Are You Ready?
What every PT, PTA, and practice owner needs to know about the 2025 Medicare Final Rule.
Friends and Colleagues,
Let's get straight to it. The Centers for Medicare & Medicaid Services (CMS) has dropped the 2025 Physician Fee Schedule Final Rule. Still, not everyone understands it, and it’s not just another round of minor tweaks. This is a seismic shift for our profession, particularly for those of us in outpatient settings. These changes, which took effect on January 1, 2025, will fundamentally alter how we manage our administrative tasks, use our incredible Physical Therapist Assistants (PTAs), and get paid.
For years, we've been "flying by the seat of our pants" with cumbersome regulations that haven't kept pace with the reality of modern physical therapy. Now, two of the most significant administrative headaches are finally being addressed. This is news you need to understand intimately.
Game-Changer #1: The End of Chasing Physician Signatures
We'veWe'vebeen there. You create a comprehensive, evidence-based plan of care, you send it to the referring physician for a signature, and then... You wait. And wait. You follow up, the patient is in limbo, and your billing is stalled. It’s one of the most inefficient parts of our workflow.
That'That's.
Starting in 2025, the requirement for a physician or non-physician practitioner (NPP) to physically sign the initial plan of care for certification is effectively eliminated. The rule will now deem the plan of care certified if you meet two simple conditions:
You have a signed and dated written order or referral for therapy from the physician/NPP in the patient's record.
You have documented proof that you sent your plan of care to that same referring provider within 30 days of the initial evaluation.
That’s right, you are no longer responsible for hunting down the signature. The burden now shifts to the physician to review the plan and communicate any disagreements. If you hear nothing, you can proceed and bill for your services. This is a monumental win for professional autonomy and administrative relief. It allows us to focus on what truly matters: treating our patients.
A critical note: This change only applies to the initial certification. The signature requirement for recertifications and subsequent care plans remains in place.
Game-Changer #2: General Supervision for PTAs is Finally Here
For those in private practice, the "direct supervision rule” for PTAs under Medicare Part B has been a logistical and staffing nightmare. It required a licensed PT to be physically in the building and immediately available to intervene. This has been a significant barrier to care, especially in rural and underserved communities where a PTA might be the most accessible provider.
The 2025 final rule aligns the outpatient setting with every other Medicare setting by moving to general supervision.
What does this mean? The supervising PT is no longer required to be on-site. You must still be available via telecommunication (e.g., by phone or video call), but you no longer need to be in the exact physical location. This long-overdue change will:
Dramatically increase staffing flexibility for private practices.
Improve patient access to care, as PTAs can now treat patients with more autonomy.
Empower PTAs to practice at the top of their license, acknowledging their extensive training and skill.
This victory for common sense will allow us to build more efficient and responsive care models.
The Financial Reality: Cuts and Thresholds
It's not all gone; we must be transparent about the financial impact. The final rule includes another cut to the reimbursement rates. The 2025 conversion factor is set to decrease by 2.83%. This continues a painful trend of declining payments at a time when practice costs are only rising. It’s a bitter pill to swallow, alongside the positive regulatory changes, which means we must be brighter than ever about managing our practices.
On a slightly brighter note, the thresholds for targeted medical review are increasing. For 2025, the KX modifier threshold (the point at which you must attest to the medical necessity of continued care) will be $2,410 for PT and speech-language pathology services combined. The hard threshold for a potential targeted medical review remains at $3,000.
The Bottom Line for Us
The 2025 Medicare rule is a watershed moment. The newfound freedoms from chasing signatures and the constraints of direct supervision are massive victories that will streamline our work and improve patient care. We have fought for these changes for years, and they are a testament to the persistent advocacy of our professional organizations.
However, we must temper our celebration with fiscal prudence. The ongoing cuts to reimbursement are a serious threat to the viability of many practices. Now is the time to analyze your clinic's operations, educate your staff on these new rules, and prepare to leverage the administrative relief to create a more efficient and resilient practice.
The landscape is changing. Let's make sure we are ready. Let's master it.
In your service,
Brian K. Werner, PT, MPT National Director of Vestibular Education & Training, FYZICAL
Thank you!!