2026 Medicare Changes For Physical Therapy

The 2026 Medicare Final Rule includes several key Medicare changes for Physical Therapy.

• Code 98985 – Used for remote therapeutic monitoring of the musculoskeletal system for 2 to 15 days in a 30-day period.
• Code 98979 – Used for remote therapeutic monitoring treatment management services including at least 10 minutes of a qualified professional’s time and one real-time interactive communication with the patient or caregiver per month

These codes are considered “sometimes therapy” codes and will require a therapy plan of care.

The KX modifier threshold in 2026 for combined physical therapy and speech-language pathology services remains at $2,480 and occupational therapy remains at $2,480. The threshold for targeted medical review remains at $3,000 for combined physical therapy and speech-language pathology services and $3,000 for occupational therapy services.

Temporary telehealth privileges have expired for Rehab Therapists and no legislation has been passed to either add them to the list of eligible telehealth providers or to extend the temporary privileges.

There will be a stronger emphasis on medically necessary documentation especially when the KX modifier is used. Practice workflows and documentation should be modified to reduce denial risks.

The final rule includes a -2.5% efficiency adjustment that is aimed at non-timed procedures. Most physical therapy codes are timed in 15-minute increments so they are not subject to the adjustment but untimed codes such as 97014, 97010, and 97012 will be subject to the adjustment.