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The Centers for Medicare and Medicaid have officially reversed its prior interpretation that excluded Clinical Fellowship and Speech Language Pathologists holding provisional licenses from billing Medicare. Now, provisional or temporary license holders (including Clinical Fellowship and Speech Language Pathologists) are eligible to bill Medicare Part B for outpatient speech language pathology services so long as they meet their state’s licensure/license in process requirements.
The revised guidance defers to each state’s licensing process to determine whether provisional licensees can practice, aligning with 42 CFR 410.62(a), 42 CFR 484.115(n), and Medicare Benefit Policy Manual Section 230.3
CMS now considers provisional licensees in compliance with federal requirements if they follow their state’s licensure pathway, including temporary licensure tied to supervised experience.
This is great cause now, Clinical Fellowship and Speech Language Pathologists can enroll as Medicare providers, obtain their own NPI, and bill Part B services directly provided their state permits provisional licensing during the Clinical Fellowship year.
The Centers for Medicare and Medicaid policy reversal restores career pathways for newly graduated Speech Language Pathologists and supports access to care for Medicare beneficiaries. Private practices, employers, Clinical Fellowship and Speech Language Pathologists should review state licensure laws and payer policies to ensure compliance while maintaining quality care.

¨If you or someone you know might need physical therapy, please call us at 305-570-1633, or if you are interested in opening a Physical Therapy Franchise. Email us franchise@physicaltherapynow.com or visit our website at https://physicaltherapynow.com/franchise/

In today’s increasingly diverse communities, clinics and private practices are seeing more patients who speak little or no English. This has raised an important and sometimes confusing question: Is a clinic required to pay for an interpreter when a patient requests one?
The short answer is: Yes, if the clinic receives any form of federal funding.

Patients with Limited English Proficiency face significant barriers when accessing healthcare. Miscommunication can lead to poor health outcomes, missed diagnoses, and legal risk. Federal law recognizes this and mandates language access for LEP individuals in certain situations.
Under Section 1557 of the Affordable Care Act and reinforced by the Nondiscrimination in Health Programs and Activities Final Rule (2024), any healthcare provider that receives federal financial assistance is required to provide and pay for qualified interpreter services when needed.
This includes:
-Clinics participating in Medicaid or CHIP
-Clinics billing for Medicare Part B services
-Facilities involved in Medicare Advantage (Part C) or Medicare Part D plans
-Any healthcare provider receiving grants from HHS or participating in ACA Marketplace plans

Using family members or minors as interpreters is strongly discouraged and often noncompliant, as it may compromise accuracy, privacy, and ethics.
Providing interpreter services isn’t just a legal obligation, it’s a commitment to quality care and equity. By ensuring LEP patients can fully understand their care, clinics protect themselves legally and help build trust in the communities they serve.
If you’re unsure whether your clinic qualifies under federal guidelines or how to set up interpreter services, consult with a healthcare compliance expert or legal advisor.

Arthritis is one of the leading causes of pain and disability in the United States, affecting millions of people, especially older adults. If you’re living with arthritis, you know how joint stiffness, swelling, and pain can disrupt your daily life. While medication can offer relief, many people prefer to manage their arthritis naturally, without relying on long-term drug use. The good news about that is that Physical therapy offers powerful, drug-free solutions to reduce arthritis pain, restore mobility, and improve your quality of life.

Arthritis is not just one condition, it’s a general term for joint inflammation. The most common types include:
-Osteoarthritis: “Wear and tear” arthritis that breaks down cartilage over time.
-Rheumatoid Arthritis: An autoimmune disease causing joint inflammation and damage.
-Psoriatic Arthritis, Gout, and others also affect joints and surrounding tissue.

No matter the type, arthritis can cause pain, stiffness, and decreased range of motion. Movement is medicine for arthritis. A licensed physical therapist will create a tailored exercise plan to increase joint flexibility and range of motion, build muscle strength to support weak joints, improve balance and stability and reduce joint stress during daily activities. Gentle exercises like stretching, resistance training, and aquatic therapy are often included. The benefits are no side effects from medications, better balance and fewer falls and a stronger sense of control over your health.
You don’t have to rely solely on medication to manage your arthritis. Physical therapy offers a safe, effective, and personalized way to relieve pain, move better, and regain your freedom naturally.

If you or a loved one is struggling with arthritis, let our physical therapists help. Contact Physical Therapy Now to schedule your evaluation and start your journey toward pain free living today.

Whether you’re a weekend warrior, a high school athlete, or a pro competing at the highest level, an injury can be one of the most frustrating setbacks. It doesn’t just affect your body, it takes a toll on your confidence, your performance, and sometimes your identity. But here’s the good news: physical therapy is one of the most powerful tools available to get you back in the game stronger, smarter, and safer than before.
Return to sport isn’t just about being pain free or cleared by a doctor. It’s about being physically and mentally ready to perform at your pre injury level or higher without risking re-injury.

A structured return to sport program focuses on:
Full range of motion and strength restoration
Sport specific movements and agility
Cardiovascular fitness and endurance
Mental readiness and confidence
Prevention of future injuries

Physical therapists design customized plans that replicate the specific movements and intensity of your sport, whether it’s sprinting, pivoting, swinging, or jumping. Injury often leads to muscle atrophy, weakness, and imbalances. The Physical Therapy will guide the patients through a progressive strengthening program, starting with controlled movements and gradually building to high load, explosive exercises that reflect the game-day performance.

The recommendation is to start as soon as possible, cause early intervention leads to faster healing, fewer complications, and a more efficient return to play timeline. Whether you’ve had surgery, suffered a sprain, or just feel “off,” a physical therapist can evaluate your condition and start you on a smart path to recovery.

On July 14th of 2025, the Centers for Medicare & Medicaid Services released the CY 2026 Medicare Physician Fee Schedule proposed rule (CMS‑1832‑P), opening a 60 day public comment period through September 12th of 2025. This proposed rule outlines significant updates affecting physician payments, telehealth policies, quality reporting, and how care models are rewarded under Medicare Part B.

Centers for Medicare and Medicaid Services proposes a –2.5% efficiency cut to work RVUs for non time based codes, reflecting improved practice efficiencies. E/M visits, care management, behavioral health, maternity, and telehealth codes are excluded. Centers for Medicare & Medicaid Services aims to standardize payments regardless of care setting, using facility data to align RVUs between private practices and hospital outpatient settings.

Telehealth & Virtual Supervision Advances
Permanently permit direct supervision via real time audio and video for selected services. Propose permanent telehealth waivers for rural health clinics and federally qualified health centers and remove provisional telehealth distinctions, making most services permanently eligible.

Innovation in Care Models & Quality Programs
Launching the Ambulatory Specialty Model (ASM): a mandatory 5 year pilot starting on January 2027 for heart failure and low back pain care. Introducing add on codes for Advanced Primary Care Management, including behavioral health integration.

Quality Payment Program (QPP) updates:
-New MIPS Value Pathways
-Stable performance thresholds through 2028
-Digital and nutrition measures under consideration

All these matters for Physical Therapy providers cause the boost to PFS conversion factor positively affects timed codes central to Physical Therapy billing, also expanded site neutral policies could shift therapy from hospital outpatient settings to private clinics, it will have telehealth permanence and a lot of value based opportunities.

The CY 2026 PFS proposed rule marks a significant step in enhancing physician and therapy reimbursement, promoting telehealth permanence, and incentivizing value based, site neutral care. For physical therapy providers, it’s an opportunity to adapt, advocate, and align with evolving Medicare reform.

In an important policy update, the Centers for Medicare & Medicaid Services has revised the Medicare Benefit Policy Manual to clarify and tighten the qualifications for speech language pathologists, delivering outpatient therapy services to Medicare beneficiaries. The change has significant implications for Clinical Fellow SLPs, especially in billing and service delivery across all outpatient settings.
As of April 18, 2025, Centers for Medicare & Medicaid Services has removed language from Section 230.3 of the manual that previously allowed clinical fellows to treat Medicare patients under supervision. The revised language now requires all SLPs billing Medicare outpatient therapy services to fully meet licensure and post graduate experience requirements, effectively disqualifying CFs with provisional licenses from treating Medicare outpatients.

To be recognized as a qualified provider of outpatient speech therapy services under original Medicare, a speech language pathologist must:
– Hold a Master’s or Doctoral degree in speech-language pathology (since Jan 1, 2015)
– Be licensed by the state in which services are provided

In states without licensure:
-Complete 350 supervised clinical hours
-Complete 9 months of supervised, full-time practice post-degree
-Pass a national examination approved by HHS

The American Speech Language Hearing Association is currently in communication with CMS. The American Speech Language Hearing Association is actively advocating for the recognition of provisional licensees as qualified Medicare providers. Their goal is to reverse the policy change and allow CF SLPs to participate in Medicare outpatient services under defined conditions.
This 2025 CMS update brings major implications for staffing, billing, and supervision in outpatient speech therapy. While it enhances clarity on qualifications, it also limits the flexibility of practices employing CFs. At Physical Therapy Now, we remain committed to delivering compliant, high-quality care and supporting our therapists through evolving regulations.

In a recent update, the Centers for Medicare & Medicaid Services (CMS) has made a significant change that impacts how hospital outpatient therapy departments bill and receive reimbursement for Remote Therapeutic Monitoring (RTM) services. Understanding this change is essential for accurate billing and ensuring proper reimbursement, especially as Remote Therapeutic Monitoring becomes a growing part of modern therapy care.
Centers for Medicare and Medicaid Services are changing the Status Indicator for two key CPT codes used in Remote Therapeutic Monitoring:

CPT 98980 – RTM treatment management services, 1st 20 minutes

CPT 98981 – Each additional 20 minutes of RTM treatment management

These codes are shifting from status indicator B to status indicator A. The status indicator B is not reimbursed under the Outpatient Prospective Payment System when billed by hospitals on a UB-04 claim (Bill Types 12x or 13x). The satus indicator A now separately reimbursable under the Medicare Physician Fee Schedule, but still not reimbursed under OPPS for hospitals. So, CPT 98980 and 98981 are now payable, but only under the physician fee schedule, not OPPS. Hospitals billing under the OPPS must route these claims through the correct billing channels to receive reimbursement. This change is retroactive to January 1, 2025. That means any claims with dates of service on or after 1/1/25 should follow the new billing rule.
This change by CMS reflects the ongoing shift in how technology driven services like Remote Therapeutic Monitoring are integrated and reimbursed across healthcare settings. While RTM continues to offer tremendous value for physical therapy patients, providers must be vigilant with billing accuracy to ensure reimbursement under evolving Medicare rules.

NCCI Edits version 31.2 now in effect. As of July 1, 2025, the National Correct Coding Initiative (NCCI) Edits Version 31.2 is officially in effect and will remain active through September 30, 2025. These edits are critical to ensure proper coding and billing in all outpatient therapy settings for both original Medicare and Medicaid beneficiaries. Whether you’re a provider or a billing professional, staying compliant with the latest NCCI updates is essential for avoiding denials and maintaining proper reimbursement.

National Correct Coding Initiative edits are coding rules published by CMS (Centers for Medicare & Medicaid Services) to:
-Prevent improper payment when incorrect code combinations are billed
-Promote accurate and ethical billing practices
-Ensure services are reported in a standardized, non-duplicative way

These edits include bundled code pairs, mutually exclusive edits, and the need for appropriate modifiers (like Modifier 59 or X-modifiers) when billing certain code combinations together. While CMS has not yet released the detailed summary of changes for Version 31.2 publicly, the quarterly updates typically involve:

-New bundling edits: CPT code pairs that can no longer be billed together unless modifiers are used
-Updated rationale for existing edits
-Revised guidance on modifier usage

Therapists and billing teams must closely review the current NCCI tables and cross reference them with their EMR or billing system to ensure claims submitted during Q3 July 1 to September 30, 2025 comply with the edits. At Physical Therapy Now, our billing and compliance teams stay ahead of these quarterly changes to ensure we deliver not only excellent care but accurate, timely claims submissions.

If you’re an Aetna member looking to begin physical therapy, your road to recovery just got easier. Aetna has announced two major policy changes that remove long-standing administrative barriers to care. These changes mark a significant step toward improving patient access and autonomy in outpatient physical therapy.
What Are the Two Big Changes?
Effective June 17, 2025, Aetna will implement the following updates:
No Physician’s Order Required for Physical Therapy: Patients with Aetna coverage will no longer need a referral or order from a physician before starting outpatient physical therapy services. This streamlines access to care and supports the growing trend of direct access, where patients can begin treatment without waiting for a doctor’s approval.
The second update is No Physician Signature Required on the Plan of Care: Physical therapists are now no longer required to obtain a physician’s signature or approval for the written plan of care. This change allows therapists to begin and adjust treatment plans based on clinical judgment without added administrative hurdles. These changes mark a major step forward in removing unnecessary barriers to timely rehabilitation services.

These updates take effect on June 17, 2025. Claims submitted for services provided on or after that date will be subject to the new guidelines and Aetna has clarified that these updates apply only to outpatient physical therapy services.

Aetna’s decision to eliminate the physician order and signature requirements for physical therapy is a win for patients, therapists, and care access overall. By simplifying the process, Aetna is aligning with evidence-based practices that support direct access and empower physical therapists to deliver care quickly and effectively.

As more states across the U.S. adopt direct access laws, allowing patients to see a physical therapist without a doctor’s referral, many Medicare beneficiaries are asking:
“Can I start physical therapy without a referral under Medicare?”

The answer is not quite. While state laws may allow direct access, the Medicare program has its own rules when it comes to outpatient therapy services. Direct access means you can visit a licensed physical therapist without a physician’s referral or prescription. Most states support this model, giving patients faster, more convenient access to care—especially for issues like back pain, joint stiffness, or post-surgical recovery. However, Medicare operates under a federal program, and its payment rules are separate from state licensure laws.
The Medicare program does not formally recognize direct access for outpatient physical, occupational, or speech therapy services. This means Medicare requires specific documentation from a physician or nonphysician practitioner (NPP) to reimburse therapy services, even if state laws allow direct access. But that doesn’t mean you can’t start therapy. If your state allows direct access, a Medicare beneficiary can be evaluated by a therapist without a referral.

Medicare doesn’t officially recognize direct access the way private insurance might, but that doesn’t mean you can’t start therapy without a referral. The key is making sure all necessary documentation and physician certification are in place to ensure coverage.
¨If you or someone you know might need physical therapy, please call us at 305-570-1633, or if you are interested in opening a Physical Therapy Franchise. Email us franchise@physicaltherapynow.com or visit our website at https://physicaltherapynow.com/franchise/

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