Medicare Cuts & Opportunities

When you adjust for inflation, OT and PT reimbursement is down around 40% since 2002 on our key CPT codes.

Now the 2026 Physician Fee Schedule proposed rule has ANOTHER cut to OT written in pencil. We simply cannot sustain continued cuts to the value of our services.

So, we clearly need to reconsider our advocacy approach and identify key opportunities to help influence meaningful change..

At OT Potential we are equipping YOU to raise your voice. In this live webinar and course, we are going to spend an hour diving deep into the relevant parts of the new proposed rule, so you can understand the challenges and opportunities. We’ll be led by The incredible Dana Strauss, a doctor of physical therapy and healthcare public policy expert.

See the comment letter template and visuals mentioned in this episode.

• You will identify the proposed cuts to occupational therapy and physical therapy in the 2026 proposed physician fee schedule.

• You will be able to identify the opportunity that exists for you to comment on proposed changes.

• Intro (5 minutes)

• Discussion on Medicare cuts & opportunities

  1. What is the physician fee schedule? Why is it important?

  2. What cuts have OT/PT sustained over the past 20 years? How does this compare to other providers like PCPs and behavioral health providers? How about medical specialists?

  3. What new cut is being proposed?

  4. What is the difference between time-based reimbursement codes and non-time based reimbursement codes?

     • Which providers typically bill time-based codes at least some of the time and why?

     • Why might OT/PT be being viewed differently than other time-based providers?

  5. How to OTs/PTs comment on this proposal and why does that matter? What do other providers often do?

  6. Do comments really matter?

  7. A template for commenting on the proposed rule, and what steps you ended up taking to comment by Sept. 12th.

• Live Q&A

• Exploring Reimbursement Pathways for Lifestyle Medicine and Health Promotion Services in Occupational Therapy

• Higher Frequency of Acute Occupational Therapy Services Is Associated With Reduced Hospital Readmissions

• Comprehensive analysis of trends in Medicare utilization and reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017

It is the policy of OT Potential to disclose any financial and non-financial interest the provider or instructor may have in a product or service mentioned during an activity. This is to ensure that the audience is made aware of any bias of the speaker.

OT Potential pays guest speakers an honorarium for their participation, either directly or to an institution of the speaker's choosing at their request. We invite guests whose expertise often comes from practices, programs, or building products in their field. Where a speaker has a financial interest in the subject of a course, we disclose it below so you can weigh it for yourself.

OT Potential's interest in this topic: We have no financial stake in the payment policies discussed in this course, and no business relationship with CVS Health or Aetna.

Speaker interests: Dana Strauss is Senior Director of Public Policy and Government Affairs at CVS Health, where she leads public policy for value-based care and Medicare provider policy. CVS Health has commercial interests in the payment policies discussed in this course. Her views are her own and do not represent those of her employer.