2024 Physical Therapy Fee Schedule: What PTs Need to Know

Much like every final rule from the Centers for Medicare & Medicaid Services (CMS), the 2024 final fee schedule brings important updates for physical therapy professionals, such as the changes in the guidelines for overseeing physical therapy assistants, new rules for caregiver education, and the ongoing use of telehealth services. Staying informed on these changes is crucial for the effective management of billing and compliance within your practice.

In this post, we highlight these critical changes in the final rule of the 2024 Fee Schedule.

Main Takeaways From This Article: 

• The 2024 Physical Therapy Fee Schedule introduces significant changes, including a decrease in the conversion factor by 3.4%, adjustments to reimbursement rates for specific CPT codes, and updates in guidelines for overseeing occupational therapy assistants and caregiver education.
• These changes have substantial implications for billing and compliance within physical therapy practices. It's essential for professionals to stay informed about the new rules, including those for telehealth, the revised PTA supervision rules, and the introduction of new caregiver training codes.
• To adapt to these changes, clinics need to reassess their fee schedules considering the new reimbursement rates and insurance policies, use technology to optimize operations, and continuously review their pricing strategy in response to the evolving healthcare market. 
• Adopting comprehensive physical therapy software tools, like Empower EMR, can facilitate compliance with new regulations, streamline billing processes, and enhance patient care for healthcare providers.

Understanding the 2024 PTA Reimbursement Changes

In June 2023, The American Physical Therapy Association (APTA), the American Occupational Therapy Association, and other associations came together to urge lawmakers to bring reforms to the Medicare fee schedule in order to address the challenges faced by therapy providers. 

Fast forward to 2024, the physical therapy reimbursement rates are going to change significantly. The conversion factor, a key element for calculating final payment amounts for various codes, will be reduced by 3.4%. 

However, this decrease is less than the originally expected 4.2%. These changes are due in part to the new application of certain management and evaluation add-on codes, as revealed by the CMS.

2024 vs. 2023 Reimbursement Rates

• CPT Code 97110: Therapeutic exercises will decrease from $29.82 (2023) to $28.82 (2024).
• CPT Code 97112: Neuromuscular reeducation decreases from $34.23 (2023) to $33.07 (2024).
• CPT Code 97140: Manual therapy drops from $27.45 (2023) to $26.52 (2024).
• CPT Code 97530: Therapeutic activities will decrease from $37.62 (2023) to $36.02 (2024)
• CPT Code 97116: Gait training therapy will shift from $29.82 (2023) to $28.82 (2024)

Other Notable Updates

The final 2024 Physical Therapy Fee Schedule has some important updates. This includes adjustments to the KX modifier thresholds. Now, a cap of $2,330 has been set for Physical Therapy, Speech-Language Pathologist, and occupational therapy services. The medical review threshold, however, will stay at $3,000 until 2027. Additionally, after feedback from the APTA about certain codes used often by PTs being unfairly low, the CMS has asked the AMA RUC to re-evaluate these rates. As a result, there's a chance that the costs tied to 19 therapy codes could increase.

New caregiver training codes have also been introduced in the final rule. These allow PTs and other medical professionals to bill for training caregivers, even if the patient isn't there. The definition of a caregiver has also been expanded to not just include a patient's immediate family. On the topic of telehealth, significant changes have been made. Occupational therapists can now work in institutional settings using the 95 modifiers to participate in the expanded telehealth offerings through 2024.

Finally, supervision rules for PTAs have been relaxed. This allows physical therapists in private practice to oversee their assistants more broadly and comes with an extended option for virtual supervision and simpler rules for remote therapeutic monitoring (RTM).

How To Set Your Clinic Fee Schedule for 2024

While configuring your clinic's fee schedule for 2024 might seem overwhelming, you can manage it effectively by following a few essential steps.

• Assess Market Conditions: Keep an eye on changes in costs, what you charge compared to others, and the current rate of inflation.
• Understand Insurance Reimbursements: Factor in any changes to insurance policies and reimbursement rates.
• Analyze Historical Data: Use your clinic's past financial performance to predict future requirements and plan accordingly.
• Forecast Future Expenses: Take into account potential increases in rent, utilities, salaries, and equipment costs.
• Set Transparent Fees: Let your clients know about your fee structure upfront to maintain trust.
• Leverage Technology: Consider implementing efficient and cost-effective technologies to reduce operational costs.
• Regular Review: Continuously evaluate and adjust fees in response to changes in the healthcare market and the economy at large.

With these steps, you can create a fee schedule that promotes your clinic's financial health while providing valuable services to your patients.

Billing Implications of the 2024 Medicare Physician Fee Schedule

There's no doubt that the final 2024 Medicare Physician Fee Schedule (PFS) rolled out by the Centers for Medicare & Medicaid Services (CMS) on November 2 is going to impact your billing process. Here is a breakdown of the changes you need to look out for: 

1. In 2024, CMS conversion factor rates decreased to $32.7375 and $20.4349 for anesthesia, marking a 3.4% and 3.3% decline from 2023.
2. A new add-on code, G2211, now applies for E/M services requiring significant medical decision-making involvement.
3. Telehealth services provided at home now qualify for higher non-facility PFS rates.
4. Medicare will continue reimbursing telehealth services listed in its service catalog through 2024.
5. The performance threshold for all three MIPS reporting options remains at 75 points.
6. MIPS has introduced five new value pathways, which include updates to the CMS Quality Payment Program, targeting various health areas, including women's health and mental health.
7. Revisions have been made to MSSP's quality performance standards, benchmark methods, and beneficiary assignments.
8. From 2024, the APM incentive payment will phase out, and as of 2026, an APM conversion factor will take its place.

Telehealth Services Update

In 2024, Medicare's telehealth services are set for big changes, including new codes and a wider range of services. Here are key highlights to help you understand future practice trends:

• New Codes: Medicare sees the addition of temporary codes for health and wellness coaching (CPT codes 0591T - 0593T) and a permanent HCPCS code G0136 for social determinants of health risk assessments.
• Expanded Services: The Consolidated Appropriations Act (CAA) 2023 extends telehealth services to any location in the U.S., including patients' homes.
• Increased Practitioner Base: More practitioners, such as physical therapists, speech-language pathologists, and audiologists, can provide telehealth services.
• Payment Methods: There are no 'in-person' requirements for initiating mental health telehealth services for the first six months. Payments will continue as per current policies for entities like rural health clinics (RHCs) and federally qualified health centers (FQHCs).
• Mental Health Boost: Additions to the telehealth practitioner list now incorporate mental health counselors and marriage and family therapists.
• Increased Flexibility: For clinicians providing remote services, the frequency limitations are waived from 2024, affording them more flexibility.
• Learning Opportunities: Resident doctors can leverage real-time audio or video communications to meet their learning needs.
• Payment Increase: The telehealth originating site facility fee payment will rise by 4.6% in 2024.
• Policy Changes: 2024 sees minor alterations to payment policies for remote outpatient therapy services, diabetes self-management training (DSMT), and medical nutrition therapy (MNT)
• New Rules: The new final rules at 42 CFR 410.78(b)(2)(x) permit practitioners to bill for DSMT services on behalf of the DSMT entity.

The Bottom Line: Navigating the 2024 PT Fee Schedule

Staying informed about the updates in the 2024 Physical Therapy Fee Schedule is crucial for physical therapists. By understanding changes, such as reduced reimbursement rates, new billing codes for caregiver training, expanded telehealth options, and relaxed supervision rules for PT assistants, physical therapists can ensure accurate billing, compliance, and continued high-quality patient care. 

Equipping yourself with a comprehensive physical therapy software suite like Empower EMR can help you effectively tackle these changes. 

Empower EMR provides a full suite of physical therapy software tools to keep your finger on the pulse of all aspects of your practice, including Medicare’s ever-changing compliance requirements. It helps you:

• Fulfill compliance requirements by staying informed about the latest regulations and updates.
• Streamline the billing process to ensure accurate reimbursements.
• Provide better patient care with specialized tools to deliver exceptional care to your patients.

So, why wait? Book a demo with EmpowerEMR today and discover firsthand how our holistic approach to EMR could bring substantial time and cost savings to your clinic.

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