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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that physical therapy (PT), occupational therapy (OT), and speech therapy (ST) services are 
covered only when they are medically reasonable and necessary. Therapy services are considered reasonable 
and necessary when: 
 
1. The services are specific and effective treatment for the patient's condition, 
 
2. The services require the skills or direct supervision of a therapist,  
 
3. The amount, frequency, and duration of the services is reasonable under accepted standards of practice, and   
 
4. The services are needed to address recovery of or improvement in function OR to establish, design, deliver, 
or carry out a maintenance program.  
 
Medicare coverage is based not on a patient's potential for improvement, but rather on the patient's need for 
skilled care. You can find these rules in the Centers for Medicare and Medicaid Services, Internet Only 
Manual, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 220.2. 
 
Neuromuscular re-education: 
The rules say that this therapeutic procedure is provided for the purpose of restoring or maintaining balance, 
coordination, kinesthetic sense, posture, and proprioception (e.g., proprioceptive neuromuscular facilitation 
(PNF), BAPs boards, vestibular rehabilitation, desensitization techniques, balance and posture training). 
This procedure may be reasonable and necessary for restoring or maintaining function which has been affected 
by:  
 loss of deep tendon reflexes and vibration sense accompanied by paresthesia, burning, or diffuse pain of the 
  feet, lower legs, and/or fingers; 
 nerve palsy, such as peroneal nerve injury causing foot drop; 
 muscular weakness or flaccidity as result of a cerebral dysfunction, a nerve injury or disease or having had a 
  spinal cord disease or trauma; 
 poor static or dynamic sitting/standing balance; 
 postural abnormalities; 
 loss of gross and fine motor coordination; 
 hypo/hypertonicity 
 Therapeutic activities: 
The rules say that therapeutic activities are considered reasonable and necessary for patients needing a broad 
range of rehabilitative techniques that involve movement. Movement activities can be for a specific body part 
or could involve the entire body. This procedure involves the use of functional activities (e.g., bending, lifting, 
carrying, reaching, catching, pushing, pinching, grasping, transfers, bed mobility and overhead activities) to 
restore or maintain functional performance. The activities are usually directed at a loss or restriction of 
mobility, strength, balance, or coordination. They require the skills of the therapist to design the activities to 
address a specific functional need of the patient and to instruct the patient in their performance. These dynamic 
activities must be part of an active treatment plan and must be directed at a specific outcome. 
 
In order for therapeutic activities to be covered, the following requirements must be met: 
 
 the patient has a documented condition for which therapeutic activities can reasonably be expected to restore 
  or maintain functioning; 
 there is a clear correlation between the type of therapeutic activity performed and the patients underlying 
  medical condition; 
 the patients condition is such that he/she is unable to perform the therapeutic activities without the skilled 
  intervention of the qualified professional/auxiliary personnel. 
 
You can find this information at Local Coverage Determination (LCD)-Outpatient Physical and Occupational 
Therapy Services (L34049). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.