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.

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 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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