Outpatient Rehabilitation (Physical Therapy, Occupational Therapy) - Medicare Advantage

This policy covers outpatient rehabilitation therapy services—physical therapy, occupational therapy, and speech-language pathology—for Medicare Advantage members, including care after illness, injury, or surgery and for conditions such as lower-limb amputation, carpal tunnel, chronic pain, and other musculoskeletal disorders. Coverage is limited to skilled, reasonable and necessary services provided under an individualized, physician‑certified plan of care with objective documentation of functional deficits and an expectation of measurable improvement; custodial, unskilled, purely maintenance, or convenience services and claims lacking required documentation/signatures are not covered and are subject to applicable CMS NCDs/LCDs and provider licensing requirements.

"Heat Treatment, Including the Use of Diathermy and UltraSound for Pulmonary Conditions — NCD 240."