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.
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:
- Treatment Diagnosis
- Long Term Goals
- Type of Service, Amount, Duration, Frequency
Where can a physical therapist find more information?
The 3 best resources for more information are:
- Medicare Benefit Policy Manual – CMS Chapter 15 Section 220 – 230
- Your state practice act
- Your state’s physical therapy association website
Read more:
How to create a superbill for cash based therapy, out of network claims Office Ally Practice Mate
The CMS 1500 form is the gold standard for superbills. If you are giving cash based clients a superbill or helping clients submit out of network claims this tutorial will walk you through the entire process from start to finish for using a FREE Practice Mate account to create and print a CMS 1500.
Medicare Physical Therapy Claim and Reimbursement Analysis – How to create a profitable practice
Medicare reimbursement for physical therapy has been on the decline for several years now and with the proposed reductions coming in the next year physical therapy clinic owners are looking for new business models. The way it has always been done isn’t going to bring you success in your physical therapy practice moving forward.
How much does medicare part b pay for physical therapy
If you want to learn how to look up the Medicare CMS Physician Fee Schedule for 2020 and specifically for physical therapy, occupational therapy, or speech language pathology, WATCH THIS VIDEO.
Telehealth – Using ScreenCapture, Canva, and A Digital Goniometer To Measure ROM (FREE)
Telehealth for physical and occupational therapy has been growing in popularity lately. Along with this growth, therapists are looking for new and easy to use tools. This simple goniometer can be added to your screen capture to measure joint range of motion.
Medicare Guidelines for Billing Therapeutic Exercise 97110 PT, OT in 2020
“Many therapeutic exercises may require the unique skills of a therapist to evaluate the patient’s abilities, design the program, and instruct the patient or caregiver in safe completion of the special technique. However, after the teaching has been successfully completed, repetition of the exercise, and monitoring for the completion of the task, in the absence of additional skilled care, is non-covered. For example, as part of the initial therapy program following total knee arthroplasty (TKA), a patient may start a session on the exercise bike to begin gentle range of motion activity. Initially the patient requires skilled progression in the program from pedal-rocks, building to full revolutions, perhaps assessing and varying the
seat height and resistance along the way. Once the patient is able to safely exercise on the bike, no longer requiring frequent assessment and progression, even if set up is required, the bike now becomes an “independent” program and is no longer covered by Medicare.”
