This page is a central location for rehabilitation therapy services information, including CMS resources.

Spotlight

• Therapy Services

• Comprehensive Outpatient Rehabilitation Facilities and Outpatient Physical Therapy Providers: Understanding the Differences

• MLN Fact Sheet MLN905365, Complying with Outpatient Rehabilitation Therapy Documentation Requirements

• Documentation Requirements for Physician and Non-Physician Practitioners

Policy Information

Not all services have a policy associated with them. We will consider Reasonable and Necessary Guidelines in the absence of an LCD, billing and coding article, NCD, or CMS manual instruction that limits coverage. 

• CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 1, Section 110
• CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 8, Section 30
• CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 12
• CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 220 and 230

Medical Documentation

For a claim to be valid, documentation must demonstrate compliance with all applicable coverage, coding and billing requirements and substantiate the level of care billed. The following resources are specific to rehabilitation therapy, but may not address all required medical documentation requirements:

• Medical Documentation Checklists 
• Checklist: Outpatient Therapy and Rehabilitation Services (PT, OT, ST)
• Medicare Provider Compliance Tips: Comprehensive Outpatient Rehabilitation Facility Services
• MLN Fact Sheet MLN905365, Complying with Outpatient Rehabilitation Therapy Documentation Requirements
• Physical Therapy Plan of Care Requirements
• TPE: Part A Review Topics
• TPE: Part B Review Topics

Claim Submission and Reimbursement

• CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 4, Section 200
• CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 5

• Coding Guidelines: Part A Outpatient Therapy Billing at a Glance

• Counting Units for Timed Codes
• Multiple Procedure Payment Reduction

• Resolution Tips for Overlapping Claims

• Medicare Deductible, Co-Insurance and Therapy Thresholds
• MLN Booklet MLN1783722, Proper Use of Modifiers 59, XE, XP, XS & XU
• Therapy Modifiers

Additional Information

• View our FastTrack to Medicare Coverage Policies Tool to locate guidelines

CMS

• Therapy Services

Education

View our wide selection of free, live and on-demand training options:

• View our upcoming Educational Events Calendar
• View On-Demand Learning

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