Page 188 - Medicare Benefit Policy Manual

function, decrease in severity or rationalization for an optimistic outlook to justify
continued treatment. Improvement is evidenced by successive objective measurements
whenever possible (see objective measurement and other instruments for evaluation in
the §220.3.C of this chapter). If an individual’s expected rehabilitation potential is
insignificant in relation to the extent and duration of therapy services required to achieve
such potential, rehabilitative therapy is not reasonable and necessary.

Rehabilitative therapy services are skilled procedures that may include but are not limited
to:

• Evaluations and reevaluations;

• Establishment of treatment goals specific to the patient’s disability or
dysfunction and designed to specifically address each problem identified in
the evaluation;

• Design of a plan of care addressing the patient’s disorder, including
establishment of procedures to obtain goals, determining the frequency and
intensity of treatment;

• Continued assessment and analysis during implementation of the services at
regular intervals;

• Instruction leading to establishment of compensatory skills;

• Selection of devices to replace or augment a function (e.g., for use as an
alternative communication system and short-term training on use of the device
or system); and

• Training of patient and family to augment rehabilitative treatment. Training
of staff and family should be ongoing throughout treatment and instructions
modified intermittently as the patient’s status changes.

Rehabilitative therapy requires the skills of a therapist to safely and effectively furnish a
recognized therapy service whose goal is improvement of an impairment or functional
limitation. (See definition of therapist in section 220.A of this chapter.) Services that can
be safely and effectively furnished by nonskilled personnel or by PTAs or OTAs without
the supervision of therapists are not rehabilitative therapy services.

Rehabilitative therapy may be needed, and improvement in a patient’s condition may
occur, even when a chronic, progressive, degenerative, or terminal condition exists. For
example, a terminally ill patient may begin to exhibit self-care, mobility, and/or safety
dependence requiring skilled therapy services. The fact that full or partial recovery is not
possible does not necessarily mean that skilled therapy is not needed to improve the
patient’s condition or to maximize his/her functional abilities. The deciding factors are
always whether the services are considered reasonable, effective treatments for the