Things You Should Know: 2025 Updates!

1. Reduction in Medicare Conversion Factor for 2025

The Centers for Medicare & Medicaid Services (CMS) has announced a decrease in the conversion factor for 2025, dropping it to $32.3465 from $33.29 in 2024. This reduction impacts reimbursement rates for various physical therapy services.

2. Revised Multiple Procedure Payment Reduction (MPPR) Rates

CMS has updated the MPPR rates for 2025. The MPPR applies a 50% reduction to the practice expense component of certain "always therapy" services when multiple procedures are provided to a patient on the same day. The service with the highest practice expense relative value unit is paid at 100%, while subsequent services are reimbursed at 50%.

3. Increase in KX Modifier Threshold

For 2025, the KX modifier threshold has been raised to $2,410 for combined physical therapy (PT) and speech-language pathology (SLP) services, and $2,410 for occupational therapy (OT) services. The KX modifier is used to indicate that services exceeding these thresholds are medically necessary.

4. Proposed Shift to General Supervision for PTAs

CMS has approved changing the supervision requirement for physical therapist assistants (PTAs) in private practices from direct to general supervision. This means PTAs can perform services without the supervising physical therapist being physically present, potentially increasing flexibility in service delivery.

5. Telehealth Services Extension as of 3/17/25:

The ability for physical therapists, occupational therapists, and speech-language pathologists to furnish telehealth services has been extended through September 30th, 2025. This extension allows continued access to therapy services via telehealth platforms.