Physical Therapist | Physicaltherapynow.com

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.

¨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 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/

Physical Therapy Now was founded in 2015 by visionary entrepreneur Andy Zapata in Miami, Florida, born from a simple yet powerful mission: to restore movement, function, and hope for people of all walks of life. As a seasoned healthcare executive and advocate for underserved communities, Andy understood the profound impact that quality rehabilitative care can have—not just on individuals, but on families and communities as a whole.

The concept for Physical Therapy Now was developed through hands-on experience. Andy opened and operated five highly successful clinics across South Florida, each one serving as a testament to a model that combined evidence-based care with personalized attention, operational excellence, and culturally competent service. These clinics quickly earned a reputation for putting patients first, reducing pain, improving quality of life, and helping individuals regain their independence with dignity and compassion.

Recognizing the growing demand for accessible, high-quality physical therapy services—and driven by the success of these initial locations—Andy decided to expand the impact of his proven model through franchising. Thus, in the same year of its founding, Physical Therapy Now began its journey as a franchise company, empowering other entrepreneurs and healthcare professionals to bring the same level of care to their own communities.

Since its inception as a franchise, Physical Therapy Now has grown to include more than 50 locations across three states, including Florida and Texas. This growth has been fueled not just by market demand, but by a deeply rooted commitment to operational support, clinical excellence, and a strong community ethos. Franchise owners are supported with comprehensive training, marketing strategies, billing and compliance systems, and ongoing mentorship to ensure they succeed—not only as business owners but as healthcare leaders.

Today, Physical Therapy Now stands as a symbol of resilience, innovation, and accessibility in rehabilitative care. Each clinic operates with a consistent mission: to provide life-changing services to patients while building meaningful relationships within the communities they serve. Whether helping someone recover from surgery, manage chronic pain, or improve mobility after an accident, every therapist and support team member is driven by a common purpose: to help people live healthier, more active lives.

As Physical Therapy Now continues to grow, the vision remains clear—to become the most trusted name in physical rehabilitation across the United States, delivering exceptional care while uplifting the communities that need it most. Guided by its core values—Patients First, Teamwork with Heart, and Now Matters—the company is more than a network of clinics. It is a movement, redefining what it means to care in the modern age.

Understanding Two Powerful Paths to Pain Relief and Healing

When you’re dealing with back pain, neck stiffness, or recovering from an injury, you might wonder:
Should I see a physical therapist or a chiropractor? The good news is, both physical therapy and chiropractic care are valuable, non-surgical options for addressing pain, restoring function, and improving your quality of life. But they take different approaches — and knowing the difference can help you choose the care that’s right for you. Physical therapy (PT) focuses on helping patients restore movement, strength, balance, and function after injury, illness, or surgery. PTs use scientifically based techniques to treat the underlying cause of pain or dysfunction. Physical therapy is often used after surgeries, sports injuries, strokes, or chronic conditions like arthritis. It’s a progressive, functional approach focused on helping you get back to your normal activities — or better than before.

Chiropractic care is a healthcare discipline that focuses on diagnosing and treating mechanical disorders of the spine and musculoskeletal system, especially misalignments (called subluxations). Chiropractors aim to restore proper spinal alignment, improve nerve function, and relieve pain — especially back and neck pain, headaches, and joint discomfort. Care often involves regular adjustments to maintain alignment over time. Some clinics even offer collaborative care, where PTs and chiropractors work together to get you faster results.
Both professions are dedicated to helping you live pain-free — just through different approaches.

As healthcare reimbursement continues to decline and operational costs rise, many organizations are searching for ways to optimize billing and increase revenue per outpatient therapy visit. One question we’ve heard more frequently is: “Can a hospital bill HCPCS code G0463 every time a patient receives outpatient physical, occupational, or speech therapy?” To help clarify this issue, we’re breaking down what G0463 represents, when it can be billed, and why it does not apply to therapy-specific revenue codes. According to the 2025 HCPCS Level II coding manual, G0463 is defined as: “Hospital outpatient clinic visit for assessment and management of a patient.” This code is used by hospitals to report clinic visits where evaluation, treatment planning, and coordination of care occur in a hospital outpatient setting.

Hospitals are allowed to bill G0463 for outpatient clinic visits that involve assessment and management services. These are typically medical or primary care-related appointments, not therapy services. To be valid, G0463 must be paired with a supporting revenue code that aligns with clinic or evaluation-type services. Hospitals should not bill G0463 when a patient attends an outpatient therapy session for physical, occupational, or speech therapy. The revenue codes associated with therapy services (042x, 043x, 044x) are not aligned with the clinic-based evaluation and management services required for billing G0463. Trying to bill G0463 in this context could lead to denials, compliance issues, or audit risk. As hospitals and therapy clinics navigate financial pressures, it’s important to optimize billing within the rules. While G0463 can be a valid code for hospital-based outpatient clinic visits, it does not apply to therapy services billed under the appropriate therapy revenue codes.

Un enfoque culturalmente sensible para el bienestar y la independencia. En nuestras comunidades latinas, los adultos mayores son pilares fundamentales de nuestras familias. Son abuelos, madres, padres, y sabios consejeros. Y como tal, merecen una vida activa, saludable y digna.

Pero con los años, es común experimentar dolor, rigidez, caídas, o pérdida de movilidad. La buena noticia es que la terapia física puede ayudar a prevenir estos problemas y mejorar la calidad de vida, todo sin necesidad de medicamentos invasivos o cirugías costosas.

En Physical Therapy Now, entendemos las necesidades físicas, emocionales y culturales de nuestros adultos mayores latinos. Aquí te contamos cómo la terapia física puede marcar una gran diferencia. La terapia física no es solo para atletas o personas que han tenido una cirugía. Para los adultos mayores, es una herramienta poderosa que mejora el equilibrio y previene caídas, fortalece músculos débiles y mejora la movilidad, reduce el dolor crónico, como el de rodillas, espalda o artritis, ayuda a recuperar la independencia para caminar, cocinar o cuidar a los nietos y promueve la salud mental y emocional al mantenerse activo y conectado.
En Physical Therapy Now, muchos de nuestros terapeutas y personal hablan español y entienden nuestra cultura. Sabemos que no se trata solo del cuerpo,también tratamos con respeto, calidez y paciencia. Nos tomamos el tiempo para explicar, escuchar y apoyar en cada paso del proceso. Cuando nuestros pacientes se sienten como en casa, los resultados son mejores. Aquí no solo sanamos cuerpos, tambien fortalecemos espíritus.

Si usted o alguien que conoce necesita terapia física, por favor llámenos al 305-570-1633.
Si está interesado en abrir una franquicia de Physical Therapy Now, envíenos un correo a franchise@physicaltherapynow.com o visite nuestro sitio web en https://physicaltherapynow.com/franchise/

What you need to know before starting treatment. If you’re considering physical therapy to recover from an injury, manage chronic pain, or improve mobility, you might be wondering: “Is physical therapy covered by my insurance?” The good news is that in most cases, yes. Most major health insurance plans—including Medicare, Medicaid, and private insurers like Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield—do cover physical therapy services. Coverage usually depends on:
Medical necessity

A referral or prescription from your doctor

Your plan’s deductible and copayments

Depending on your insurance plan and state laws: Some plans require a referral from your primary care doctor or a specialist. Others allow direct access, meaning you can schedule an evaluation with a physical therapist without a referral. In the clinic, the front desk person always verifies your coverage and referral requirements before your first visit—so there are no surprises. If you don’t have insurance, that doesn’t mean you can’t get care. Here at Physical Therapy Now, we offer: Affordable self-pay rates, discounted therapy packages, flexible payment plans. Your health shouldn’t have to wait because of coverage issues. Our goal is to make your experience easy, affordable, and stress-free. If you’ve been putting off therapy because of insurance questions, we’re here to help.
Call your nearest Physical Therapy Now clinic and we’ll walk you through your benefits, coverage, and options—so you can start your recovery journey today.

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