Billing and Coding: Medical Necessity of Therapy Services

Medicare covers therapy services only when medical records document that the skills of a qualified clinician are necessary, the clinician provides a unique professional contribution, and objective/functional measures (PLOF, initial evaluation, and regular progress reporting) demonstrate significant, sustainable benefit. Services provided by therapy aides, non-skilled repetitive exercise, supervision of independent exercise, or activities that can be performed by non-skilled personnel are not reimbursable; progress reports are required at least every ten treatment days and physician certification intervals may extend up to 90 days.

"Therapy services are covered when provided by a qualified clinician (physician, non-physician practitioner, therapist, or speech-language pathologist), and treatment may be provided by a PT or OT a..."

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