In Medicare Part B, which statement about physical therapy reimbursement is true?

In Medicare Part B, which statement about physical therapy reimbursement is true?

• A. PT that is not skilled can be reimbursed
• B. PT must be daily for reimbursement
• C. PT plan of care does not need physician certification
• D. Only PT that is skilled, necessary and certified by the physician will be reimbursed

Answer: (D)

Medicare Part B reimbursement for physical therapy is based on three key ideas: the service must be skilled, medically necessary, and delivered under a physician-certified plan of care. In outpatient PT, the intervention must involve professional clinical judgment and oversight that only a skilled therapist provides, not routine activities that could be done without specialized training. The plan of care has to be established and periodically reviewed by a physician or other qualified professional, and it must be certified by the physician to be payable. The number of visits or the need to do it daily isn’t the controlling factor; reimbursement depends on medical necessity and the documented plan of care. Because these conditions are met only when the therapy is skilled, necessary, and physician-certified, that statement is the correct one.

Medicare Part B reimbursement for physical therapy is based on three key ideas: the service must be skilled, medically necessary, and delivered under a physician-certified plan of care. In outpatient PT, the intervention must involve professional clinical judgment and oversight that only a skilled therapist provides, not routine activities that could be done without specialized training. The plan of care has to be established and periodically reviewed by a physician or other qualified professional, and it must be certified by the physician to be payable. The number of visits or the need to do it daily isn’t the controlling factor; reimbursement depends on medical necessity and the documented plan of care. Because these conditions are met only when the therapy is skilled, necessary, and physician-certified, that statement is the correct one.