New Year, New Changes? That’s what’s going to happen this 2026 for Physical Therapists, Speech Language Therapists, and Occupational Therapists.
As the medical billing service, we’ve put together a list of 2026 CPT code changes along with other important updates you need to know about physical therapy billing and medical billing services for therapists.
Here’s why you should choose the right physical therapy billing company.
MEDICARE CAP FOR 2026
The Medicare Cap for Physical Therapy, Occupational Therapy Billing Services, and Speech-Language Pathology services has reached $2,480 in 2026. Since the hard cap has been repealed, a soft therapy cap has been imposed. Therapists must apply for the KX modifier once the cap has been met to fully receive payment for “medically necessary services.” It’s crucial for therapists to use this key phrase in their notes, alongside a complete set of documents for additional services provided past the cap.
The Medical Review Cap remains constant at $3,000. If therapy services are provided beyond the $3,000 cap, a Medicare contractor may review medical records to verify medical necessity. The annual dollar limit for the caps resets on January 1st of 2026, so the KX modifier should not be used on claims until the soft cap is reached. Improper usage of the KX modifier may lead to audits, so compliance with proper usage is essential.
2026 CPT Code Changes
Here is the list of 2026 CPT code changes.
New Untimed Codes for OT and SLP
- 96112 – Developmental test by qualified healthcare professional; first hour
- 96113 – Developmental test by qualified healthcare professional; each additional 30 min
- 96121 – Neurobehavioral status exam by a qualified healthcare professional; each additional hour
- 96130 – Psychological test by qualified healthcare professional; first hour
- 96131 – Psychological test by qualified healthcare professional; each additional hour
- 96132 – Neuropsychological eval by qualified healthcare professional; first hour
- 96133 – Neuropsychological eval by qualified healthcare professional; each additional hour
- 96136 – Psychological/neuropsychological test by qualified healthcare professional; first 30 min
- 96137 – Psychological/neuropsychological test by qualified healthcare professional; each additional 30 min
- 96146 – Psychological/neuropsychological test by standard instrument via electronic platform/auto result
New Timed Codes for Occupational Therapy and SLP
- 7151 – Behavior ID Assessment by qualified healthcare professional; each 15 minutes
- 97155 – Adaptive behavior treatment w/ protocol mod by a qualified healthcare professional; each 15 minutes
- 97156 – Family adapt behavior treatment by a qualified healthcare professional (with or without patient present); each 15 minutes
- 97157 – Multi-family group adapt behavior treatment by a qualified healthcare professional (without patient present); each 15 minutes
- 97158 – Group adaptive behavior treatment w/ protocol mod by a qualified healthcare professional (multiple patients); each 15 minutes
- 98979 – Remote therapeutic monitoring treatment management services, physician or other qualified healthcare professional time in a calendar month requiring at least 1 real‑time interactive communication with the patient or caregiver; first 10 minutes
- 98984 – Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, 2‑15 days in a 30‑day period
- 98985 – Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 2‑15 days in a 30‑day period
Retired Codes
- 96111 – Developmental Testing extended, with interpretation and report (deleted in the CPT 2026 code set)
- 64550 – Tens unit application (remains deleted for Medicare therapy claims)
Functional Limitation Reporting
Physical Therapists, Occupational Therapists, and Speech Language Therapists need NOT to have complete Functional Limitation Reporting for Medicare Part B and Railroad Medicare beneficiaries, however, commercial payers like Medicare Advantage plans and Worker’s Compensation plans, that use the Functional Limitation Reporting system are not affected by this significant change, yet, may still require FLR codes.
Six of the FLR codes (G8980, G8983, G8986, G8989, G8992, and G8995) can be used for MIPS reporting so they may continue to be used if you participate in the MIPS program.
Medicare Fee Schedule and Therapy Assistants
Here’s what you need to know about the fees starting in 2026: Medicare will pay 85% of the fee schedule for PTAs, OTAs, and COTAs when they perform 10% or more of any service. New modifiers CQ and CO will be used to report services furnished by the PTA, OTA, and COTA. This differential payment requirement has been in effect since January 1, 2022, and continues for 2026.
Although it will take effect for a few years from now on, it will directly impact the bottom-line of many practices and will require new reporting policies, and procedures so it is best to start preparing and planning now for this another significant change.
