CG-REHAB-12 Rehabilitative and Habilitative Services in the Home Setting: Physical Medicine/Physical Therapy, Occupational Therapy and Speech-Language Pathology

This policy addresses rehabilitative and habilitative services delivered in the home setting, specifically physical therapy, occupational therapy, and speech-language pathology. These services are covered as medically necessary only when both: (1) the therapy request meets the plan’s discipline-specific medical necessity criteria, and (2) the request also meets home health medical necessity criteria in CG-MED-23; services are not covered when these criteria are not met. Key limitations: applies solely to home-based care and requires simultaneous fulfillment of both therapy-specific and home health criteria for approval.

"Physical therapy, occupational therapy, or speech-language pathology services in the home setting are consideredmedically necessarywhen both of the criteria below are met:"

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