CG-REHAB-07 Skilled Nursing and Skilled Rehabilitation Services (Outpatient)

This policy addresses outpatient skilled nursing and skilled rehabilitation services (physical, occupational, and speech therapy). Coverage is provided when, under physician orders, the service’s complexity requires performance by or under the general supervision of skilled personnel and the patient’s changing condition requires skilled observation/assessment until treatment is stabilized; services must not be custodial in nature. Not covered when these criteria are not met, including when care is primarily custodial (e.g., assistance with activities of daily living, personal care, or supervision of self-administered medications).

"Outpatient skilled nursing services are consideredmedically necessaryin the followingcircumstances:"

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