There are several 2025 changes for Therapists that CMS has published in Medicare’s Final Rule that take effect on January 1, 2025. Below are some highlights of the changes that effect Therapists in 2025.
Therapy KX Modifier Thresholds
- Physical Therapy and Speech Therapy: $2,410 combined
- Occupational Therapy: $2,410
Medical Review Thresholds
- Physical Therapy and Speech Therapy: $3,000 combined
- Occupational Therapy: $3,000
New CPT Codes for Direct Caregiver Training
CMS has added three new CPT Codes for Direct Caregiver Training. The new codes can be billed when a caregiver (family member, guardian, friend, neighbor) is trained to provide care for a patient with a chronic illness or disability and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control). The new codes have been designated as “sometimes therapy” services
| CPT Code | Description | Billing Frequency |
|---|---|---|
| G0541 | Caregiver Training (Patient Not Present) – First 30 Minutes | Timed Code: 8 Minute Rule Does NOT Apply |
| G0542 | Caregiver Training (Patient Not Present) – Additional 15 Minutes | Timed Code: 8 Minute Rule Applies |
| G0543 | Group Caregiver Training (Patient Not Present) | Untimed Code |
Updates to Existing CPT Codes
| CPT Code | Description |
|---|---|
| 98975 | Set-up and patient education on use of equipment for remote therapeutic monitoring |
| 98976 | Device supply for data access or data transmissions to support monitoring of respiratory system, each 30 days |
| 98977 | Device supply for data access or data transmissions to support monitoring of musculoskeletal system, each 30 days |
| 98978 | Device supply for data access or data transmissions to support monitoring of cognitive behavioral therapy, each 30 days |
| 97811 | Acupuncture, each additional 15 minutes |
| 97814 | Acupuncture with electrical stimulation, each additional 15 minutes |
New Modifier for Audio-Only Billing
Starting January 1, 2025, Medicare will no longer accept Modifier 95 for audio-only telehealth. Instead, use Modifier 93 for auto-only sessions. So for phone consultations, use Modifier 93 and for video consultations, use Modifier 95 for codes 99441, 99442, and 99443.
Supervision of Therapy Assistants
CMS will permanently allow general supervision of a physical therapy assistant by a physical therapist and general supervision of an occupational therapy assistant by an occupational therapist instead of direct supervision as previously required. HOWEVER, your practice also needs to check your state’s supervision requirements as they may require direct supervision which would override CMS supervision requirements.
