Takeaways From the Proposed 2025 Medicare Physician Fee Schedule, Part 2

The U.S. Centers for Medicare & Medicaid Services has released the proposed 2025 Medicare Part B Physician Fee Schedule. In Part 1 of our recap, we covered the conversion factor cut, a breakthrough related to PTA supervision, and relief from a burdensome plan of care requirement for PTs. Here's a quick rundown of more elements of the proposed rule, with a focus on telehealth and the Medicare Quality Payment Program, which includes the Merit-based Incentive Payment System.

Few Changes to Existing Telehealth Policies

CMS failed to recommend adding physical therapy codes to the permanent list of codes eligible for payment when provided via telehealth, despite heavy advocacy by APTA and other providers in both the regulatory and legislative arenas. PT codes remain at provisional status, as they have been since the onset of the COVID-19 pandemic's public health emergency in March 2020. As of now, that provisional status runs through Dec. 31, 2024.

While APTA submitted specific codes for permanent status - 97110, 97112, 97116, 97161-4, 97530, and 97535 - CMS states that instead of reviewing individual codes in this proposed rule it will take a look at all provisional codes and address their status in future rulemaking. That said, the agency does propose to add the caregiver training codes (97550-2) to the provisional list in 2025.

Looking at the larger issue, as in the past, CMS says that it doesn't have the statutory authority to change its list of approved telehealth providers to include PTs. Bipartisan legislation in the U.S. House of Representatives would do exactly that, and APTA continues advocacy efforts on that front.

Concerning what constitutes telehealth, CMS proposes to include audio-only communication technology among the interactive telecommunications systems eligible for payment as telehealth. There are caveats: The technology must be two-way and real-time, and it can be used only when the patient is incapable of or doesn't consent to video technology. In making the recommendation CMS acknowledged that access to video technology is variable and that patients don't always want to engage via video in their homes. The agency added that providers would attach the 93 modifier when using audio-only communication.

If Congress adds physical therapy to the approved provider list, PTs could take advantage of this proposed allowance. However, because most physical therapy codes require the PT to have visual contact with the patient, use of audio-only telecommunication may be limited.

In a crossover with the 2025 Hospital Outpatient Prospective Payment System proposed rule released July 10, CMS states in the proposed rule that future telehealth policies under OPPS will align with policies under the physician fee schedule, in regard to communications technology when staff furnish services from the institutional facility to patients in their homes. As with PTs billing under the physician fee schedule, telehealth services by institutional PTs are provisional and will expire after Dec. 31 without legislative action.

Small Changes to Quality Payment Program

Compared with the 2024 rule, the 2025 proposed rule has few substantive changes to the QPP for the physical therapy profession. In the 2024 rule, CMS removed the exemption for physical therapy practices of 16 or more clinicians from the promoting interoperability category of MIPS. The promoting interoperability performance category is intended to promote patient engagement and the electronic exchange of information using certified electronic health record technology. For more on that reporting requirement, consult this APTA resource from staff experts.

While there are no substantial changes to these policies in the proposed rule, there are proposals that would mitigate the impact of accidental submissions and would change the weightings of certain factors.

Specifically on weighting changes, CMS proposes to allow clinicians to request reweighting for the quality, promoting interoperability, and improvement activities categories if they can't submit data for reasons beyond their control - such as a third-party contracted intermediary failing to submit data on time.

CMS also proposes to maintain its performance threshold of 75 points and data completeness threshold of 75% through the CY 2028 performance period.

Last year, CMS introduced the Rehabilitative Support for Musculoskeletal Care MVP, the first MIPS Value Pathway that PTs are able to participate in. For 2025, the agency proposes one additional MIPS quality measure and four qualified clinical data registry, or QCDR, measures for inclusion in the MVP. Q050 would identify whether women 65 and older with urinary incontinence have a documented plan of care related to pelvic floor rehabilitation. MSK6, MSK7, MSK8, and MSK9 measure patients who have neck, upper extremity, back, and lower extremity injuries, respectively, who see an improvement in their pain by the end of treatment. A proposed modified improvement activity related to COVID-19 vaccination status - IA_ERP_6 - would be added to all MIPS Value Pathways.

Next Steps

APTA is reviewing the rule and will submit comments by the Sept. 9 comment deadline, but member comments also will be critical in supporting the favorable policies while objecting to the payment cuts. Keep an eye out for APTA's member comment tool and template comment letter offerings that will make it easy to make your voice heard. On Aug. 8 at 2:30 p.m. ET, the APTA Regulatory, Legislative, and Payment Updates, August 2024 webinar will feature APTA staff experts discussing the fee schedule and other recent payment news.

While the association will be advocating for the profession around the provisions in the proposal, we will continue to advocate to both CMS and Congress for permanent solutions to fee schedule cuts. Keep up with APTA's advocacy efforts: Sign up for the APTA Advocacy Network, a free, members-only service that sends you special legislative updates and action alerts so you're up to speed and ready to act.