The fall stretch in a PT clinic, September to December

The middle of September is when a physical therapy schedule starts filling from two directions at once. Fall sports have been under way for a few weeks, so preseason ankle sprains and shoulder strains are turning into evaluations. And patients who have paid toward a deductible all year are starting to notice they are close to the line, or past it.

For many outpatient clinics, the weeks from here to the holidays are the fullest of the year. They are also the weeks with the most dates attached, and nearly all of those dates come from benefit rules rather than injuries. This is how we would plan them with a clinic.

September: the sideline and the deductible

Fall sports injuries arrive on a rhythm nobody has to forecast: Friday night games, Saturday tournaments, Monday morning calls. Two things decide whether those calls reach you. One is whether your Google Business Profile shows hours and a phone line that work for a parent at 7:30 on a Monday morning. The other is whether the athletic trainers and league organizers nearby know your name, which is a relationship rather than an ad.

The deductible side is quieter. A patient who started care in the spring may have met a calendar-year deductible by now, which changes what each remaining visit costs. Few will work that out for themselves. A front desk that mentions it, plainly and without promising coverage, keeps plans of care going that would otherwise stall.

Where your Medicare patients stand against the KX line

Medicare does not cap outpatient therapy. Medicare.gov says there is no limit on what it pays for medically necessary outpatient therapy in a calendar year, with the patient paying 20% of the approved amount after the Part B deductible, which is $283 for 2026.

There are lines, though, and fall is when long-plan patients cross them. CMS sets the 2026 KX modifier threshold at $2,480 for PT and speech-language pathology combined, and claims above it that lack the modifier are denied. Above $3,000, PT and speech therapy claims can be picked for medical review.

That reaches into marketing in two places:

• What the front desk says. A patient told they have “used up their Medicare” may cancel care they are still entitled to. They should hear that therapy continues when it is medically necessary and documented.
• What the reminders say. An October reminder to a Medicare patient near the threshold should be about the next appointment, not about benefits. Coverage questions belong in the billing conversation.

October: Physical Therapy Month and open enrollment

APTA marks October as National Physical Therapy Month. It gives a clinic a reason to appear in a local paper, a school newsletter or a chamber breakfast, and gives an athletic director a reason to say yes to a talk on injury prevention. Ask for those slots now rather than in October.

Medicare open enrollment runs from October 15 to December 7. Some older patients will switch plans for January, and a patient who switches may land on a plan your clinic does not take. Two jobs follow from that:

• Check that the plans you accept are listed correctly on your site and Business Profile before October 15.
• Have the front desk ask returning Medicare patients about plan changes at their first January visit, before anything is billed.

One more note for clinics that buy Local Services Ads. In August, Google began moving them into Google Ads as Performance Max campaigns with pay-per-lead goals, starting with home and storefront services such as plumbing and HVAC. Physical therapy was not among the categories Google named for that first phase, so a clinic’s account runs as before this fall, with the health care limits still in place: calls only, and no lead credits.

November and December: finish the plan before the reset

This is the peak for many clinics. Patients who have met their deductible want to finish care while the remaining visits cost them less, and money in health flexible spending accounts is running out. The IRS describes health FSAs as generally “use-it-or-lose-it” plans. An employer may soften that with a grace period of up to two and a half months after the plan year ends, or with a limited carryover into the next year, and some plans offer neither.

Two caveats keep the message honest. HealthCare.gov notes that a plan year may not line up with the calendar year, so “your deductible resets January 1” is not true for every patient. And a clinic cannot know which FSA option a patient’s employer chose. The right reminder is a prompt, not a promise: you have visits left on your plan of care, here are the open times before the holidays, and your own benefits and deadlines are worth a check.

That kind of message sits outside HIPAA’s definition of marketing, which leaves out a provider describing its own health care services unless a third party pays for the communication. Your compliance lead should still approve the wording, and it should carry no clinical detail. “The visits left on your plan” reads far better on a lock screen than a diagnosis does.

January, set up in September

Three things reset with the calendar year, and each needs a page or a script ready before the holidays:

• The KX count. The threshold applies per calendar year, so Medicare patients start January at zero.
• Deductibles. Medicare’s Part B deductible and calendar-year commercial deductibles start over, and some patients will pause care. A short page on what a visit costs before the deductible is met answers the question before it becomes a cancellation.
• Telehealth. CMS says Medicare telehealth by physical therapists is extended through the end of next year. If you offer it, describe it as available for now rather than permanent.

What to do this month

• Update your Google Business Profile hours, including early mornings and any Saturday sessions, before the next weekend of games.
• Email the athletic trainers at the two or three schools nearest you with a direct line for injured athletes.
• Pull a list of Medicare patients on long plans and brief the front desk on how to talk about the KX threshold.
• Check the plans you accept on your site and profile before October 15.
• Book one National Physical Therapy Month talk or article.
• Load the November “visits left on your plan” reminder into your CRM now, once your compliance lead has approved it.

A calm, full December usually belongs to the clinic that loaded its reminders in September. That is the system we build in GoHighLevel for clinics, and the rest of how we approach the trade, from direct access to tracking, is on our page for physical therapy clinics.