Page 200 - Medicare Benefit Policy Manual

A re-evaluation is focused on evaluation of progress toward current goals and making a
professional judgment about continued care, modifying goals and/or treatment or
terminating services. Reevaluation requires the same professional skills as evaluation.
The minutes for re-evaluation are documented in the same manner as the minutes for
evaluation. Current Procedural Terminology does not define a re-evaluation code for
speech-language pathology; use the evaluation code.

Plan of Care. See section 220.1.2 for requirements of the plan. The evaluation and plan
may be reported in two separate documents or a single combined document.

D. Progress Report

The progress report provides justification for the medical necessity of treatment.

Contractors shall determine the necessity of services based on the delivery of services as
directed in the plan and as documented in the treatment notes and progress report. For
Medicare payment purposes, information required in progress reports shall be written by
a clinician that is, either the physician/NPP who provides or supervises the services, or by
the therapist who provides the services and supervises an assistant. It is not required that
the referring or supervising physician/NPP sign the progress reports written by a PT, OT
or SLP.

Timing. The minimum progress report period shall be at least once every 10 treatment
days. The day beginning the first reporting period is the first day of the episode of
treatment regardless of whether the service provided on that day is an evaluation, re-
evaluation or treatment. Regardless of the date on which the report is actually written
(and dated), the end of the progress report period is either a date chosen by the clinician
th
or the 10 treatment day, whichever is shorter. The next treatment day begins the next
reporting period. The progress report period requirements are complete when both the
elements of the progress report and the clinician’s active participation in treatment have
been documented.

For example, for a patient evaluated on Monday, October 1 and being treated five times a
week, on weekdays: On October 5, (before it is required), the clinician may choose to
write a progress report for the last week’s treatment (from October 1 to October 5).
October 5 ends the reporting period and the next treatment on Monday, October 8 begins
the next reporting period. If the clinician does not choose to write a report for the next
week, the next report is required to cover October 8 through October 19, which would be
10 treatment days.

It should be emphasized that the dates for recertification of plans of care do not affect the
dates for required progress reports. (Consideration of the case in preparation for a report
may lead the therapist to request early recertification. However, each report does not
require recertification of the plan, and there may be several reports between
recertifications). In many settings, weekly progress reports are voluntarily prepared to
review progress, describe the skilled treatment, update goals, and inform physician/NPPs