The Medicare Cap has been eliminated. The APTA has been working hard to end the cap since 1997 and the goal has finally been met.

Unfortunately, Congress chose to offset the cost of the permanent fix with a last-minute addition of a payment differential for services provided by physical therapist assistants (PTAs) and certified occupational therapy assistants (COTAs). The payment differential states that PTAs and OTAs will be paid at 85% of the Medicare physician fee schedule beginning in 2022.
That pending payment differential under Medicare is somewhat comparable to that between physician assistants and physicians.

Sharon Dunn, APTA president stated that the good news is that the change will not occur until 2022. This provides time to explore solutions with the Centers for Medicare and Medicaid Services (CMS) as it develops proposed rules.

“APTA will leverage its congressional champions, the APTA Public Policy and Advocacy Committee, and the PTA Caucus on strategies to address the CMS activities,” Dunn said. “Our collective efforts will drive the association’s work to ensure that guidance to implement the new policy is favorable to PTAs and the profession, while ensuring access is not limited for those in need of our services.”