Billing and Coding: Physical Therapy - Home Health

For documentation requirements see the following reference: Medicare Benefit
Policy Manual (Pub 100-02), Chapter 7, Section 40.2. Additional documentation
requirements may be found under the appropriate CPT/HCPCS code, at:
[www.cms.hhs.gov](http://www.cms.hhs.gov/manuals/Downloads/bp102c07.pdf) . A
recent update to the documentation requirements was published in the Federal
Register on November 17, 2010 but has not yet been manualized. To view this
update, please go to the home page for [Home Health Prospective Payment
System](http://www.cms.hhs.gov/HomeHealthPPS), select 'Home Health Prospective
Payment System Regulations and Notices' and review Regulation Number CMSA
1510-F.  
  
 **General Information**  
To qualify for the Medicare home health PPS benefit, under Sections
1814(a)(2)(C) and 1835(a)(2)(A), a Medicare beneficiary must meet the
following requirements, which should be documented:  
  

  * Be confined to the home
  * Under the care of a physician
  * Receiving services under a plan of care established and periodically reviewed by a physician
  * Be in need of skilled nursing care on an intermittent basis or physical therapy or speech-language pathology, or have a continued need for occupational therapy

  
**Physical Therapy Services**  
Skilled physical therapy services are reimbursable under Medicare if the
services are documented as being:  
  

  * Ordered by a physician
  * Provided by a skilled physical therapist, or under the general supervision of a skilled physical therapist
  * Reasonable and necessary to the treatment of the illness or injury, or to the restoration or maintenance of function affected by the illness or injury
  * Provided as a result of a valid, written, physician's signed and dated plan of treatment. The plan of treatment is established prior to the provision of physical therapy services and outlines the type, amount, frequency, and duration of the physical therapy services to be provided, identifies the functional diagnosis deficits, and anticipates the short and long term goals to be accomplished
  * In accordance with the above guidelines as set forth in this LCD

  
**Signature Requirements**  
Medicare requires a legible identity for services provided/ordered. The method
used may be hand-written or electronic subject to state laws. The individual
whose name is on the alternate signature method bears the responsibility for
authenticity.  
  
 **Treatment Notes**

  * Treatment notes should be completed per visit. They should be legible and clearly relate back to the established goals. Symbols, acronyms, and notation used in treatment notes should be:  

    * Consistent with standard documentation
    * Discernable, either on their face (e.g. PT = Physical Therapy), or by supplied legends
    * Objective (e.g., 3/10 for pain)
  * Treatment notes should readily reflect all services billed.
  * Failure of treatment notes to meet the above may result in non-coverage.

  
This LCD should be interpreted to incorporate future changes in the ICD-10-CM
or CPT/HCPCS coding systems such that its original intent and scope will not
be substantively changed.  
  

  * **Utilization Guidelines**  
Throughout the LCD are stated utilization guidelines (i.e., number of visits),
and **DO NOT** imply coverage or non-coverage of a service. Services must be
reasonable and necessary for each individual and be supported by the plan of
care and other documentation.  
  

  * **Programs**  
Medicare does not cover "packaged" or "constellation of predetermined"
services (i.e., "programs"). Services must be individualized and reasonable
and necessary for each beneficiary.  
  

  * **Qualified Personnel**  
Medicare does not pay for the services provided by aides/technicians
regardless of the level of supervision. Medicare pays only for services
delivered by qualified physical therapists and physical therapy assistants.