Why Ditching CPT Codes Could Be the Best Thing Since Electric Hi-Low Tables for #PhysicalTherapy

Seasons Greetings, fellow therapists, rehab enthusiasts, and anyone who’s ever tried to decipher the enigma that is the CPT code manual without resorting to ancient hieroglyphics! Grab your favorite cup of (non-spillable) coffee, because we’re about to dive into why tossing those CPT codes out the window might just be the best thing since someone first said, “Hey, let’s make exercise balls really big and slightly unstable.”

The CPT Code Conundrum

Let’s face it: CPT codes are about as straightforward as teaching a cat to do the Macarena. They’re complex, confusing, and about as enjoyable as documenting a six-page progress note on a Friday afternoon to justify your billing codes. These codes are supposed to standardize billing, but in reality, they often feel like they’re standardizing our descent into madness.

Gaming the System (Not in a Fun Way)

The complexity doesn’t just make our lives harder — it opens the door for the system to be gamed. With codes that overlap, underlap, and perhaps even do the cha-cha when we’re not looking, it’s no wonder that billing becomes a strategic game rather than a straightforward process. And let’s be honest, if we wanted to be strategists, we’d be playing chess, not trying to get paid for helping Mrs. Smith regain her shoulder mobility by switching from therapeutic exercise to neuromuscular training to get an extra few bucks.

Re-Weighing of Codes: No Longer Practical

Every year, the AMA CPT (Current Procedural Terminology) code panel “re-weighs” CPT codes, which refers to the process of evaluating and adjusting the relative value units (RVUs) or other associated aspects of these codes. The panel reviews:

• Work RVUs: These measure the provider’s time, skill, and effort required for a procedure.

• Practice Expense RVUs: These account for overhead costs, such as equipment and staff.

• Malpractice RVUs: These reflect the cost of malpractice insurance for a procedure.

This complex, heavily politicized process once made sense at one time-for example, the re-weighing of codes years ago lowered modalities in favor of more intensive hands-on interventions like manual therapy and therapeutic exercise. But it’s process now is like sticking with an old flip phone when you have a smartphone in your pocket, insisting, ‘But I like pressing the same button three times to get a single letter.’ Nostalgic? Maybe. Practical? Not even close. 

In addition, it has been quite punishing to physical therapists. In the latest draft of the 2025 CMS Physician Fee Schedule, the proposed rate reduction sent to all providers is 2.93%. However, you have to read the fine print. The reality for physical therapists is that significant cuts to NMS re-education (4.7%) and therapeutic exercise (5.4%) through this re-weighting process.

Not Your Grandma’s Physical Therapy

CPT codes often fail to reflect the modern practices we employ daily. We’re using cutting-edge techniques, incorporating technology like virtual reality, and tailoring treatments to individual needs. Yet, we’re stuck with codes that seem to think we’re all still just doing “hot packs and massage.” It’s like trying to stream the latest Netflix series on a dial-up modem — outdated and impractical.

The Burnout Factor

The administrative burden of meticulously documenting to justify each code is leading to higher costs and, more critically, provider burnout. We entered this field to help people move better, not to become full-time clerical workers drowning in a sea of paperwork. Every minute spent wrestling with codes is a minute we’re not spending with our patients.

A Glimmer of Hope: Shaking Up the Status Quo

Here’s where things get interesting. Several outlets, including The Washington Post and Financial Times, have reported that policymakers are revisiting how the Centers for Medicare & Medicaid Services (CMS) calculate fee-for-service rates. There’s talk of removing the American Medical Association (AMA) from the process of creating CPT codes and bringing it in-house.

Show Me the Money: AMA’s Golden Goose

Why is this a big deal? Well, according to Financial Times, the AMA generates more than half of its $495 million annual revenue from CPT codes and other royalties. That’s right — over $247 million. It’s like finding out the ice cream truck down the street is also the town’s biggest gym membership salesman. Politicians have called the current process “unethical,” highlighting concerns over a private entity holding so much sway over public healthcare reimbursement. With RFK, Jr. at the helm, expect this to be at least deliberated.

A Brief History Lesson (Don’t Worry, There Won’t Be a Quiz)

The AMA’s involvement with CPT codes has a storied past. As detailed in a 2020 article by Eric Reinhart and Daniel Brauner, the AMA initially developed Relative Value Units (RVUs) in response to its opposition to government involvement in healthcare. Think of it as a “you can’t fire me, I quit” moment, but with more spreadsheets and fewer dramatic exits.

Why Abolishing CPT Codes Makes Sense for Us

Eliminating CPT codes could simplify billing, reduce administrative costs, and align reimbursement with the realities of modern physical therapy. It would mean less time justifying each code and more time doing what we do best — helping patients recover. Plus, it would reduce the potential for gaming the system, making the playing field fairer for all providers.

Wrapping It Up with a Neat (Elastic) Bow

In conclusion, getting rid of CPT codes could be the best thing to happen to physical therapy since someone first said, “Hey, maybe we should wash our hands before treatment.” It’s a move towards simplicity, transparency, and, most importantly, putting patient care back at the forefront where it belongs.

So here’s to hoping that the powers that be will see the light — or at least read this newsletter. Until then, keep your gait belts tight and your documentation (begrudgingly) thorough.

Stay strong, stay flexible.

@physicaltherapy 

larry

References:

• Reinhart, E., & Brauner, D. (2020). [Title of the article]. Journal Name, Volume(Issue), pages.
• Financial Times and The Washington Post articles on CMS and CPT codes.
• Senator Elizabeth Warren’s statements on the AMA’s role in CPT codes.