Physical Therapy
Physical therapy is a qualifying skilled service under the Medicare home health benefit. Physical therapy can be vital in rehabilitating a beneficiary after a change in condition, and increasing the beneficiary's abilities back to a functional status in the home. The services are provided with the expectation, based on the assessment made by the physician of the beneficiary's rehabilitation potential, that the condition will improve materially*in a reasonable and predictable period of time, or the service is necessary to establish a safe and effective maintenance program. A Local Coverage Determination for physical therapy services
is available to assist providers in determining appropriateness of physical therapy services, based on the beneficiary's functional condition.
All therapies (revenue codes 042X, 043X and 044X) are paid under consolidated billing. This means if a beneficiary is under a HH PPS episode, and has to have outpatient therapy due to large equipment needs, the outpatient facility must contract with the home health agency for payment.
New requirements were mandated in the Calendar Year 2011 Final Rule for therapy services provided in the home health setting for episodes beginning on or after April 1, 2011. These were published in Medicare Learning Network (MLN) Matters article, MM9119
.
Click on the items below for more details on covered physical therapy in home health.
*--The term "materially" means having real importance to consequences, to an important degree, or the improvement can be perceived in material form (objectively). In general, there should be a reasonable expectation that observable improvement in the overall safety of functional ability will occur.
- Four Principles for Medical Necessity of Therapy – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.1)
- Documenting Medical Necessity of Therapy
- Assessment – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.2A)
- Therapeutic Exercises – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.2B)
- Gait Training – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.2C)
- Range of Motion – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.2D)
- Maintenance Therapy – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.2E)
- Diathermy Treatments – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.2F)
- Wound Care – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.2.2H
Updated: 11.30.18
Reviewed: 12.10.21
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