Journal of Urgent Care Medicine

Medicare 2026 Therapy Services Update: Key Changes and What Providers Need to Know

Cindy Dickey; Tricia Krueger, CPC The Centers for Medicare & Medicaid Services (CMS) has introduced several important updates to therapy services for calendar year (CY) 2026. These changes affect reimbursement thresholds, telehealth services, coding practices, and payment reductions. Providers—including physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs)—should understand these updates to ensure compliance and optimize billing practices. One of the most notable updates is the adjustment of the KX modifier threshold. For CY …

What To Know About Payers’ Downcoding Procedures

Tricia Krueger, CPC; Nikki Benedict Insurers are drawing provider backlash for new payment policies that reduce reimbursements. For example, Cigna is automatically “downcoding” 6 evaluation and management (E/M) billing codes for a small percentage of providers, resulting in lower payments for routine services like office visits. Aetna’s new Medicare Advantage policy will automatically approve certain hospital admissions but reimburse them at the lower observation rate instead of the full inpatient rate. Providers argue these opaque …

Login to JUCM