Billing and Coding: Outpatient Physical and Occupational Therapy Services

Medicare covers outpatient physical and occupational therapy when the specialized skills of a qualified therapist are necessary to improve, maintain, or prevent decline in a beneficiary’s condition; rehabilitative and maintenance therapy are allowable only when therapist skills are required. Services that are self-administered, aimed at general fitness/welfare, or performed solely by students are not payable, and documentation must include a valid ICD-10-CM diagnosis and the referring/ordering physician’s name and NPI when required; evaluation-only encounters can serve as the plan of care when properly documented.

"Skilled therapy services are covered when the skills of a qualified therapist are necessary to improve the patient’s current condition, to maintain the patient’s current condition, or to prevent or..."

Sign up to see full coverage criteria, indications, and limitations.