Does My PT Plan of Care Need to Say Outpatient In The Home?

Question: “For mobile PTs… When you are sending a POC to the Dr are you specifically writing outpatient PT in the patients home (or something similar specifying they are being treated in their house)? If I write that I don’t want the Dr thinking home health.

Also, I know Medicare requires signed POC by Dr, do other insurances require a signed POC? I do have a referral.

Thanks!”

Answer: No, a physical therapy Medicare plan of care does not require you to indicate the place of service. Your CMS 1500 claim form will include place of service code 12 to indicate the Medicare covered service was delivered in the patient’s home.

What does a Medicare Plan of Care require?

According to Medicare Benefit Policy Manual CMS Chapter 15 section 220.1.2 B

“B. Contents of Plan (See §220.1.3 for certifying the plan.)
The plan of care shall contain, at minimum, the following information as required by
regulation (42CFR424.24, 410.61, and 410.105(c) (for CORFs)). (See §220.3 for further
documentation requirements):

1. Diagnoses;
2. Long term treatment goals; and
3. Type, amount, duration and frequency of therapy services.”

There is no requirement to indicate where the service is being delivered.

While there may not be a requirement, it may be in your best interest to document where the services and being delivered and why.

For example, if you are a physical therapist delivering outpatient physical therapy services in the patient’s home there may be a competitive advantage to treating patients in the home.

Other responses

• I just write the frequency and duration. I don’t say anything about the location.
• I just say outpatient pt.
• At the end of the cover page I have a 1 sentence blurb saying I’m mobile outpatient, adhere to CMS guidelines, and to check out my website or call my cell for any extra info
• The top of my header says “we being the clinic to YOU”! I hope that clarifies that.