Page 210 - Medicare Benefit Policy Manual

• The qualified therapist furnishing the therapy services

• The physician/NPP personally furnishing the therapy services

• The qualified therapist furnishing services incident to the physician/NPP

• The physician/NPP for incident to services furnished by qualified personnel, who
are not qualified therapists.

The qualified therapist furnishing the PT, OT, or SLP services in a CORF.

230 - Practice of Physical Therapy, Occupational Therapy, and Speech-
Language Pathology
(Rev. 63, Issued: 12-29-06, Effective: 01-01-07, Implementation: on or before 01-29-
07)

A. Group Therapy Services. Contractors pay for outpatient physical therapy services
(which includes outpatient speech-language pathology services) and outpatient
occupational therapy services provided simultaneously to two or more individuals by a
practitioner as group therapy services (97150). The individuals can be, but need not be
performing the same activity. The physician or therapist involved in group therapy
services must be in constant attendance, but one-on-one patient contact is not required.

B. Therapy Students

1. General

Only the services of the therapist can be billed and paid under Medicare Part B. The
services performed by a student are not reimbursed even if provided under “line of sight”
supervision of the therapist; however, the presence of the student “in the room” does not
make the service unbillable. Pay for the direct (one-to-one) patient contact services of
the physician or therapist provided to Medicare Part B patients. Group therapy services
performed by a therapist or physician may be billed when a student is also present “in the
room”.

EXAMPLES:

Therapists may bill and be paid for the provision of services in the following scenarios:

• The qualified practitioner is present and in the room for the entire session. The
student participates in the delivery of services when the qualified practitioner is
directing the service, making the skilled judgment, and is responsible for the
assessment and treatment.