Page 169 - Medicare Benefit Policy Manual

the services are furnished. Assistants are limited in the services they may furnish (see
section 230.1 and 230.2) and may not supervise other therapy caregivers.

QUALIFIED PERSONNEL means staff (auxiliary personnel) who have been educated
and trained as therapists and qualify to furnish therapy services only under direct
supervision incident to a physician or NPP. See §230.5 of this chapter. Qualified
personnel may or may not be licensed as therapists but meet all of the requirements for
therapists with the exception of licensure.

SIGNATURE means a legible identifier of any type acceptable according to policies in
Pub. 100-08, Medicare Program Integrity Manual, chapter 3, §3.3.2.4 concerning
signatures.

SUPERVISION LEVELS for outpatient rehabilitation therapy services are the same as
those for diagnostic tests defined in 42CFR410.32. Depending on the setting, the levels
include personal supervision (in the room), direct supervision (in the office suite), and
general supervision (physician/NPP is available but not necessarily on the premises).

SUPPLIERS of therapy services include individual practitioners such as physicians,
NPPs, physical therapists and occupational therapists who have Medicare provider
numbers. Regulatory references on physical therapists in private practice (PTPPs) and
occupational therapists in private practice (OTPPs) are at 42CFR410.60 (C)(1), 485.701-
729, and 486.150-163.

THERAPIST refers only to qualified physical therapists, occupational therapists and
speech-language pathologists, as defined in §230. Qualifications that define therapists
are in §§230.1, 230.2, and 230.3. Skills of a therapist are defined by the scope of practice
for therapists in the state).

THERAPY (or outpatient rehabilitation services) includes only outpatient physical
therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) services
paid using the Medicare Physician Fee Schedule or the same services when provided in
hospitals that are exempt from the hospital Outpatient Prospective Payment System and
paid on a reasonable cost basis, including critical access hospitals.

Therapy services referred to in this chapter are those skilled services furnished according
to the standards and conditions in CMS manuals, (e.g., in this chapter and in Pub. 100-04,
Medicare Claims Processing Manual, chapter 5), within their scope of practice by
qualified professionals or qualified personnel, as defined in this section, represented by
procedures found in the American Medical Association’s “Current Procedural
Terminology (CPT).” A list of CPT (HCPCS) codes is provided in Pub. 100-04, chapter
5, §20, and in Local Coverage Determinations developed by contractors.

TREATMENT DAY means a single calendar day on which treatment, evaluation and/or
reevaluation is provided. There could be multiple visits, treatment sessions/encounters
on a treatment day.