Medicare Attack on Our Higher-Order “Top of License” Skills in #physicaltherapy

Part of a Contrived Strategy To Further Economic Cuts

There is a well-regarded adage that says that Medicare has traditionally viewed physical therapy not as a profession to be managed but as a service to be cut. The evidence of this could not be more clear than in the proposed fee schedule for 2025. For this week’s stack, I want to address a related and more pressing issue that strikes at the very core of our profession: the specific cuts to neuromuscular re-education (NMS) and therapeutic activities (TA). While it seems arbitrary to pick on a few of many physical therapy codes, it is their disproportionate cuts that make them stand out as well as the on-going CMS strategy to cut services. More importantly, these reductions are not just financial blows but direct attacks on the higher-order skills that set physical therapists apart.

The Cuts and Their Implications

In the latest draft of the 2025 CMS Physician Fee Schedule, the proposed rate reduction sent to all providers is 2.93%. Like most things from CMS coiffers, don’t believe the fine print. The reality for physical therapists is that significant cuts to NMS re-education (4.7%) and therapeutic exercise (5.4%) will weigh their overall cut much greater because there is generally a higher use of these more advanced clinical competencies. This proposed cut, demonstrates CMS is trying to eliminate PT’s as both a profession and a service as it will make seeing medicare patients an ethical balance of wanting to treat patients that needs us most but at rates that are likely less than cost. By the way, in Medicare logic the explanation for the reduction in those two codes is simply their growing and increased use. Yes, reimbursement (along with research) drives practice-in this case not something CMS receives well. What should be applauded for the use of these advanced competency codes is thus punished and the skills of PT further marginalized. Expect to see medicare patients given the worst appointment times, extended wait lists, and handouts for recommendations to other centers willing to take patients at below cost.

Furthermore, NMS re-education and therapeutic activities are where we, as physical therapists, truly shine. These interventions require deep knowledge, precise skills, and advanced understanding — what I like to call the “neck up” skills. They allow us to work at the top of our licenses, delivering the high-level care our patients need and deserve. They also require much more documentation strength than the intervention of its easier cousin, therapeutic exercise (also reduced by 1.7%). In effect, the reductions of NMS and TA render the differential meaningless as they drive to get PT’s to practice at a lower level one that is highly commoditized.

The Slippery Slope

The slippery slope here is alarming. As these cuts continue, we risk higher-order interventions being valued the same as basic therapeutic exercises. A similar trend has been seen in evaluation codes which been drastically reduced for years. There’s a clear attempt to “dummy down” our profession, reducing our advanced skills to mere exercise instruction and home programs. This devaluation undermines our expertise and also threatens the quality of care we can provide.

The Financial Impact

Let’s not forget the broader financial context. By 2025, the total impact on physical therapists, considering both the cumulative conversion factor cuts and inflation, will be approximately 13.93% (10.33% cumulative conversion factor cut + 3.6% inflation increase). This significant reduction in real terms is compounded by the unprecedented inflation rates we’ve seen over the past few years: 7% in 2021, 6.5% in 2022, 3.4% in 2023, and roughly 3% year-to-date in 2024.

Why This Matters

These cuts are more than just numbers on a page. They represent a systematic effort to slow down and reverse growth and reduce advanced interventions and services for our seniors. Neuromuscular re-education and therapeutic activities are not just services we provide — they are critical components of effective rehabilitation that rely on our extensive training and expertise.

Our Call to Action

We cannot sit back and let these cuts go unchallenged. It’s crucial for us to advocate for the value of our profession and the high-level skills we bring to the table. As previously posted, stay close to APTA’s advocacy page (if you are not a member, join as this is when we need you most!), Private Practice Section, or if you are a member of APTQI.

@physicaltherapy