Outpatient Physical Therapy

Outpatient physical therapy is covered when services are skilled, performed by or under a licensed physical therapist, and are furnished under a written plan of care established by a physician/NPP or qualified physical therapist addressing specific, measurable goals. Specific modalities and procedures (e.g., debridement, casts/splints/strapping, traction, vasopneumatic devices, iontophoresis, US, whirlpool) are covered when documented indications are present and the services are reasonable and necessary; routine nursing care and non-skilled maintenance or treatments not requiring a therapist are excluded from coverage.

"Outpatient physical therapy (PT) is covered when services are of a level of complexity or the patient's condition is such that services can be safely and effectively performed only by a licensed ph..."

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