Page 215 - Medicare Benefit Policy Manual

qualified physical therapist who makes an onsite supervisory visit at least once every 30
days or more frequently if required by state or local laws or regulation.

The services of a PTA shall not be billed as services incident to a physician/NPP’s
service, because they do not meet the qualifications of a therapist.

The cost of supplies (e.g., theraband, hand putty, electrodes) used in furnishing covered
therapy care is included in the payment for the HCPCS codes billed by the physical
therapist, and are, therefore, not separately billable. Separate coverage and billing
provisions apply to items that meet the definition of brace in §130.

Services provided by aides, even if under the supervision of a therapist, are not therapy
services and are not covered by Medicare. Although an aide may help the therapist by
providing unskilled services, those services that are unskilled are not covered by
Medicare and shall be denied as not reasonable and necessary if they are billed as therapy
services.

D. Application of Medicare Guidelines to PT Services

This subsection will be used in the future to illustrate the application of the above
guidelines to some of the physical therapy modalities and procedures utilized in the
treatment of patients.

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

A. General

Occupational therapy services are those services provided within the scope of practice of
occupational therapists and necessary for the diagnosis and treatment of impairments,
functional disabilities or changes in physical function and health status. (See Pub. 100-
03, the Medicare National Coverage Determinations Manual, for specific conditions or
services.)

Occupational therapy is medically prescribed treatment concerned with improving or
restoring functions which have been impaired by illness or injury or, where function has
been permanently lost or reduced by illness or injury, to improve the individual’s ability
to perform those tasks required for independent functioning. Such therapy may involve:

• The evaluation, and reevaluation as required, of a patient’s level of function by
administering diagnostic and prognostic tests;

• The selection and teaching of task-oriented therapeutic activities designed to
restore physical function; e.g., use of woodworking activities on an inclined table
to restore shoulder, elbow, and wrist range of motion lost as a result of burns;