Page 230 - Medicare Benefit Policy Manual

• A hospital may bill Medicare for outpatient therapy (physical therapy,
occupational therapy, or speech-language pathology) services that it furnishes
to its outpatients either directly or under arrangements in the hospital's
outpatient department. If a hospital furnishes medically necessary therapy
services in its outpatient department to individuals who are registered as its
outpatients, those services must be billed directly by the hospital using bill
type 13X or 85X for critical access hospitals. Note that services provided to
residents of a Medicare-certified SNF may not be billed by the hospital as
services to its outpatients.

• When a hospital sends its therapists to the home of an individual who is
registered as an outpatient of the hospital but who is unable, for medical
reasons, to come to the hospital to receive medically necessary therapy
services, the services must meet the requirements applicable to outpatient
hospital therapy services, as set forth in the regulations and applicable
Medicare manuals. The hospital may bill for those services directly using bill
type 13X or 85X for critical access hospitals.

• If a hospital sends its therapists to provide therapy services to individuals who
are registered as its outpatients and who are residing in the non-certified part
of a SNF, or in another residential setting (e.g., a group home, assisted living
facility or domiciliary care home), the hospital may bill for the services as
hospital outpatient services if the services meet the requirements applicable to
outpatient hospital therapy services, as set forth in the regulations and
applicable Medicare manuals.

• A hospital may make an arrangement with another entity such as an
Outpatient Rehab Facility (Rehabilitation Agency) or a private practice, to
provide therapy services to individuals who are registered as outpatients of the
hospital. These services must meet the requirements applicable to services
furnished under arrangements and the requirements applicable to the
outpatient hospital therapy services as set forth in the regulations and
applicable Medicare manuals. The hospital uses bill type 13X or 85X for
critical access hospitals to bill for the services that another entity furnishes
under arrangement to its outpatients.

• Where the provider is a public health agency or a hospital in a rural
community, it may enter into arrangements to have outpatient physical
therapy services furnished in the private office of a qualified physical therapist
if the agency or hospital does not have the capacity to provide on its premises
all of the modalities of treatment, tests, and measurements that are included in
an adequate outpatient physical therapy program and the services and
modalities which the public health agency or hospital cannot provide on its
premises are not available on an outpatient basis in another accessible
certified facility.