Clarify what each contract pays
Resolve payer products, Medicare base years, carveouts, and effective dates. See which contracts pass Medicare changes through, which remain fixed, and the annual revenue impact.
Practice financial intelligence
Fulcrum for Physical & Occupational Therapy.
Plan for payment changes, negotiate with market evidence, and identify likely underpayments. Model how timed codes, visit patterns, units, and payer rates affect reimbursement.
Financial visibility for Physical & Occupational Therapy
Code mix, units, and payer terms shape reimbursement.
Fulcrum Light combines reimbursement terms, utilization, and published rates so therapy leaders can compare expected payment by code, payer, and service line. Integrated adds encounter and cost data for margin analysis.
Fulcrum Light
Turn your contracts and claims into a plan.
Start with a claims export and your contract set. Fulcrum adds payer-published in-network rates to model your payment exposure and compare your position in the market. No EMR integration required.
Plan for revenue changes
Forecast claim-line changes by service, location, and provider. Toggle proposed policies, compare scenarios, and save analyses to rerun when your data changes.
Negotiate with market evidence
Compare rates with other groups contracted with the same payer, by insurance product. Model proposals on your volume and use monthly rate history to inform contracting and growth decisions.
Focus underpayment review
Check claims against contract terms and payer-published rates, then review EOB evidence to screen false positives. Continuous service includes a monthly report, appeal evidence, and next steps.
What becomes answerable
Move from reported revenue to financial context.
- 01Which contracts pass Medicare changes through, and when?
- 02Which payments need underpayment review?
- 03How will a proposed rate change affect revenue?
- 04Where do our rates lag the market?
CY 2027 proposed PFS
What the proposed rule could change.
A national specialty average is useful context, not a practice forecast. Your result depends on your codes, volume, locality, sites of service, and Medicare-linked contracts.
+3.5%CMS RVU-based estimate
+3.3%Fulcrum reconstruction
Proposed change in RVU-based allowed charges, before the separate conversion-factor adjustment.
CMS's projected overall impact for Physical & Occupational Therapy
CMS's own reconciliation table (Table D-B5) puts physical & occupational therapy at +3.5% for 2027. That figure is the specialty-wide, volume-weighted change in total RVU-based allowed charges: the aggregate gain or loss across every code the specialty bills, before the separate conversion-factor cut. Fulcrum's reconstruction estimates +3.3%, a net gain of $139 million in national allowed charges.
Physical & Occupational Therapy bills about 100% of its Medicare dollars in the office (non-facility) setting, where nearly all of the change lands.
All figures are national, hold 2025 utilization fixed, and exclude the separate conversion-factor adjustment. CMS proposes a 1.68% reduction for non-qualifying APM participants and a 1.19% reduction for qualifying APM participants. These adjustments are separate from the RVU-based changes shown above.
The charts exclude conversion-factor changes. The −1.68% adjustment noted in the category chart applies to non-qualifying APM participants; the proposed adjustment for qualifying participants is −1.19%.
Gains are consistent across most practitioners.
How Fulcrum models the PFS →
CMS's practitioner-level file shows gains are consistent across most PT/OT practitioners. 93% of physical & occupational therapy practitioners land in the +2 to +5% band, and about 98% see an increase above 2%. Where a practice lands is a question of service mix: the physical & occupational therapy practices that gain the most are those with the highest therapy-code volume, which gains from the practice-expense redistribution.
Practice-specific analysis
See your practice’s revenue impact.
Choose a one-time analysis or continuous planning with Fulcrum Light. Both start with your claims and contracts; no EMR integration is needed.