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Which providers are allowed to certify a Medicare physical therapy plan of care?

There are several types of healthcare providers that are allowed to certify a Medicare physical therapy plan of care.

  • Medical Doctor
  • Doctor of Osteopathic Medicine
  • Nurse Practitioner
  • Physician’s Assistant
  • Clinical Nurse Specialist

Providers not allowed to certify a Medicare Part B physical therapy plan of care:

  • Doctors of Dental Surgery
  • Doctors of Dental Medicine
  • Chiropractors
  • Podiatrists – “Certifications and recertifications by doctors of podiatric medicine must be consistent with the scope of the professional services provided by a doctor of podiatric medicine as authorized by applicable state law.”
  • Optometrists may order and certify only low vision services.

Most common errors related to Medicare Part B physical therapy plan of care certification.

Below is a screenshot of the most common outpatient rehabilitation therapy CERT errors.

Screenshot of CMS CERT Certify Medicare Physical Therapy Plan of Care Errors

Which providers are allowed to refer Medicare patients to outpatient physical therapy?

It is important to understand the distinction between referal to physical therapy services and certification of a therapy services plan of care.

Referral to Physical Therapy

A referral to physical therapy is when a physician or nonphysician practitioner generates an order for the patient to receive physical therapy treatments. While most states offer physical therapists in private practiec some level of direct access, other states still require a physician referral.

Certification of a Physical Therapy Plan of Care

The certification of a physical therapy plan of care often superceeds a referral to physical therapy as it requires a signature from the physician or nonphysician practitioner and attestation that the physical therapy plan of care is medically necessary and the patient is currently under the care of the physician/NPP.

220.1.1 – Care of a Physician/Nonphysician Practitioner (NPP)

According to CMS Chapter 15 page 166 “Although there is no Medicare requirement for an order, when documented in the medical record, an order provides evidence that the patient both needs therapy services and is under the care of a physician.” Link

* Note: Since Medicare Part B does not require a referral for outpatient physical therapy services, a physical therapist must ensure compliance with state practice act guidelines.

What are the Medicare Part B physical therapy plan of care requirements?

Read this article for a detailed article on the required elements of a Medicare Part B physical therapy plan of care.

Simply put, Medicare requires the following 3 elements in a plan of care:

  1. Treatment Diagnosis
  2. Long Term Goals
  3. Type of Service, Amount, Duration, Frequency

Where can a physical therapist find more information?

The 3 best resources for more information are:

  1. Medicare Benefit Policy Manual – CMS Chapter 15 Section 220 – 230
  2. Your state practice act
  3. Your state’s physical therapy association website

Read more:

Physical Therapy ReEvaluation CPT Code 97164

What is a Physical Therapy Reevaluation CPT Code 97164? According to Medicare A53309 CPT Code 97164: "Re-evaluations are separately reimbursable when the medical record supports that the patient's clinical status or condition required the additional evaluative service....