Home Health Outpatient Therapies Coverage Guidelines
Medicare Part B reimburses outpatient physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services if the services are:
- provided to a beneficiary who has Part B of the Medicare benefit;
- furnished under the care of a physician, who is certifying the services are medically necessary;
- reasonable and necessary to the treatment of the illness or injury, or to the restoration or maintenance of function affected by the illness or injury; and
- furnished under a written plan of care (POC).
Refer to the following links for information about outpatient therapy services.
- Medicare National Coverage Determinations (NCDs) Manual (CMS Pub 100-03)
- Medicare Benefit Policy Manual (CMS Pub 100-02) Chapter 15 "Covered Medical and Other Health Services"
- Medicare Claims Processing Manual (CMS Pub 100-04) Chapter 5 "Part B Outpatient Rehabilitation and CORF/OPT Services
- Medicare Learning Network (MLN) Matters article, MM8036, "Manual Medical Review of Therapy Services"
- Home Health Outpatient Therapy Billing Web page
Updated: 11.29.18
Reviewed: 12.10.21