Vermont physical therapists say Medicaid code change will slash pay for in‑home infant evaluations and worsen access

Vermont physical therapists testified during APTA advocacy day that a federal restriction on an early‑intervention evaluation code has sharply reduced reimbursement for in‑home evaluations, a change they say will force some providers to stop accepting Medicaid‑only patients and will deepen existing access and workforce problems.

Heidi Wilhelm, president of the Vermont chapter of the American Physical Therapy Association and a clinician who treats infants in-home, said federal guidance now limits use of the early‑intervention evaluation code (referred to in testimony as T1023 and, at times in the discussion, as “T23”), and that the change cut an in‑home evaluation payment "from $350 for that in‑home evaluation to $84." Wilhelm said that drop makes it financially impossible for some small practices to continue serving Medicaid‑only families: "I have patients waiting. I only take Vermont Medicaid. Unfortunately, there's not enough providers, so I have a waiting list. I have to say no to families that call me," she said.

The panelists said the federal restriction means individual clinicians can no longer bill that higher‑value evaluation code for repeated in‑home…