Page 228 - Medicare Benefit Policy Manual

therapy services by the state in which he or she performs such function or action.
Direct supervision requirements are the same as in 42CFR410.32(b)(3). The
supervisor must be present in the office suite and immediately available to furnish
assistance and direction throughout the performance of the procedure. It does not
mean that the physician/NPP must be present in the same room in the office
where the service is performed.

C. The services must be of a level of complexity that require that they be performed
by a therapist or under the direct supervision of the therapist, physician/NPP who
is licensed to perform them. Services that do not require the performance or
supervision of the therapist, physician/NPP, are not considered reasonable or
necessary therapy services even if they are performed or supervised by a
physician/NPP or other qualified professional.

D. Services must be furnished under a plan of treatment as in §220.1.2 of this
chapter. The services provided must relate directly to the physician/NPP service
to which it is incident.

230.6 - Therapy Services Furnished Under Arrangements With
Providers and Clinics
(Rev. 36, Issued: 06-24-05, Effective: 06-06-05, Implementation: 06-06-05)

References: See also Pub. 100-01, chapter 5, §10.3.

A. General

For rules regarding services provided under arrangement, see Pub. 100-01, chapter 5,
§10.3.

A provider may have others furnish outpatient therapy (physical therapy, occupational
therapy, or speech-language pathology) services through arrangements under which
receipt of payment by the provider for the services discharges the liability of the
beneficiary or any other person to pay for the service.

However, it is not intended that the provider merely serve as a billing mechanism for the
other party. For such services to be covered the provider must assume professional
responsibility for the services.

The provider’s professional supervision over the services requires application of many of
the same controls that are applied to services furnished by salaried employees. The
provider must:

• Accept the patient for treatment in accordance with its admission policies;