Outpatient Physical and Occupational Therapy Services

Medicare Part B covers outpatient physical and occupational therapy when services are reasonable and necessary, require the unique skills of a qualified therapist (or equivalently trained physician/NPP), and are intended to improve function or to maintain/prevent decline when such maintenance cannot be safely performed by the patient or unskilled caregivers. A therapist-developed plan of care certified by a physician/NPP and documentation of goals, objective measures, frequency, and duration are required; evaluations are billable as one untimed unit per episode and screenings, recreational/fitness activities, predetermined packaged programs, and services by non-authorized personnel are not covered.

"Rehabilitative therapy is covered when the patient has potential to improve or is improving, maximum improvement is not yet attained, and anticipated improvement is attainable in a reasonable and g..."