Page 211 - Medicare Benefit Policy Manual

• The qualified practitioner is present in the room guiding the student in service
delivery when the therapy student and the therapy assistant student are participating
in the provision of services, and the practitioner is not engaged in treating another
patient or doing other tasks at the same time.

• The qualified practitioner is responsible for the services and as such, signs all
documentation. (A student may, of course, also sign but it is not necessary since the
Part B payment is for the clinician’s service, not for the student’s services).

2. Therapy Assistants as Clinical Instructors

Physical therapist assistants and occupational therapy assistants are not precluded from
serving as clinical instructors for therapy students, while providing services within their
scope of work and performed under the direction and supervision of a licensed physical
or occupational therapist to a Medicare beneficiary.

3. Services Provided Under Part A and Part B

The payment methodologies for Part A and B therapy services rendered by a student are
different. Under the MPFS (Medicare Part B), Medicare pays for services provided by
physicians and practitioners that are specifically authorized by statute. Students do not
meet the definition of practitioners under Medicare Part B. Under SNF PPS, payments
are based upon the case mix or Resource Utilization Group (RUG) category that
describes the patient. In the rehabilitation groups, the number of therapy minutes
delivered to the patient determines the RUG category. Payment levels for each category
are based upon the costs of caring for patients in each group rather than providing
specific payment for each therapy service as is done in Medicare Part B.

230.1 - Practice of Physical Therapy
(Rev. 179, Issued: 01-14-14, Effective: 01-07-14, Implementation: 01-07-14)

A. General

Physical therapy services are those services provided within the scope of practice of
physical therapists and necessary for the diagnosis and treatment of impairments,
functional limitations, disabilities or changes in physical function and health status. (See
Pub. 100-03, the Medicare National Coverage Determinations Manual, for specific
conditions or services.) For descriptions of aquatic therapy in a community center pool
see section 220C of this chapter.

B. Qualified Physical Therapist Defined
Reference: 42CFR484.4

The new personnel qualifications for physical therapists were discussed in the 2008
Physician Fee Schedule. See the Federal Register of November 27, 2007, for the full