Page 213 - Medicare Benefit Policy Manual

• admitted to membership by the APTA; or

• admitted to registration by the American Registry of Physical Therapists;
or

• graduated from a 4-year PT curriculum approved by a State Department of
Education; or

• licensed or registered and prior to January 1, 1970, they had 15 years of
full-time experience in PT under the order and direction of attending and
referring doctors of medicine or osteopathy.

Or, PTs meet requirements if they are currently licensed and they were trained
outside the U.S. before January 1, 2008, and after 1928 graduated from a PT
curriculum approved in the country in which the curriculum was located, if that
country had an organization that was a member of the World Confederation for
Physical Therapy, and that PT qualified as a member of the organization.

For outpatient PT services that are provided incident to the services of physicians/NPPs,
the requirement for PT licensure does not apply; all other personnel qualifications do
apply. The qualified personnel providing PT services incident to the services of a
physician/NPP must be trained in an accredited PT curriculum. For example, a person
who, on or before December 31, 2009, graduated from a PT curriculum accredited by
CAPTE, but who has not passed the national examination or obtained a license, could
provide Medicare outpatient PT therapy services incident to the services of a
physician/NPP if the physician assumes responsibility for the services according to the
incident to policies. On or after January 1, 2010, although licensure does not apply, both
education and examination requirements that are effective January 1, 2010, apply to
qualified personnel who provide PT services incident to the services of a physician/NPP.

C. Services of Physical Therapy Support Personnel

Reference: 42CFR 484.4

Personnel Qualifications. The new personnel qualifications for physical therapist
assistants (PTA) were discussed in the 2008 Physician Fee Schedule. See the Federal
Register of November 27, 2007, for the full text. See also the correction notice for this
rule, published in the Federal Register on January 15, 2008.

The regulation provides that a qualified PTA is a person who is licensed as a PTA unless
licensure does not apply, is registered or certified, if applicable, as a PTA by the state in
which practicing, and graduated from an approved curriculum for PTAs, and passed a
national examination for PTAs. The phrase, “by the state in which practicing” includes
any authorization to practice provided by the same state in which the service is provided,
including temporary licensure, regardless of the location or the entity billing for the
services. Approval for the curriculum is provided by CAPTE or, if internationally or