• Physical therapists provide critical health care services to beneficiaries under Medicare Part B to help individuals remain in their homes, communities and society at their highest possible level of function. Currently, the Medicare physician fee schedule is used to pay for outpatient physical therapy services. Therefore, physical therapists are acutely aware of the threat of annual fee schedule reductions, the cost to repeal the flawed sustainable growth rate (SGR) formula, and the impact on beneficiaries’ access to health care providers.

    APTA has developed an alternative payment system which moves payment for outpatient therapy services from the current fee-for-service, procedural-based payment system to a per-session system that considers the severity of a patient's condition and intensity of therapist services required in a session. By adopting this alternative payment system, the outpatient therapy cap and associated cost of its annual exceptions process is no longer necessary.

    APTA's goal is to create a payment system that promotes high-quality care and reflects the clinical reasoning and judgment of a therapist, while maximizing healthcare resources.

  • Last Updated: 6/24/2015
    Contact: advocacy@apta.org