Physical Therapy Services

40.2 - Physical Therapy Services (Rev. 111, Issued: 09-25-09; Effective Date: 07-07-08; Implementation Date: 10-26- 09) A qualified physical therapist, as defined at 42CFR485.70(e), has the knowledge, training, and experience required to evaluate and reevaluate, as appropriate, a patient's level of function, determine whether a physical therapy program could reasonably be expected to improve, restore, or compensate for lost function, and recommend to the physician a plan of treatment. The skills of a qualified physical therapist are required to evaluate and reevaluate the patient's level of function and to develop, in consultation with the physician as appropriate, the physical therapy plan of treatment. A qualified physical therapist assistant (PTA), as defined at 42CFR485.70(e), functioning under the supervision of the qualified physical therapist may carry out certain procedures of the physical therapy plan of treatment, in accordance with applicable State laws. Only the physical therapist, not the PTA can conduct the discharge visit as this visit is viewed as the final assessment of the patient’s progress toward attaining the goals of the physical therapy plan of treatment. Physical therapy is not required to effect improvement or restoration of function when a patient suffers a temporary loss or reduction of function (e.g., temporary weakness resulting from prolonged bed rest after major abdominal surgery) that can reasonably be expected to improve spontaneously as the patient gradually resumes normal activities. Accordingly, physical therapy furnished in such situations is not considered reasonable and necessary for the treatment of the individual's illness or injury and the services are excluded from coverage. All therapy coverage and documentation guidelines (except for development of plan of treatment) noted in Pub. 100-02, Benefit Policy Manual, chapter 15, sections 220- 220.3(E) apply to the CORF setting. NOTE: Supervision of CORF physical therapy services requires that the physical therapist must be on the premises of the CORF or must be available to the physical therapy assistant through direct telecommunications for consultation and assistance during the CORF’s operating hours. (See 42CFR485.58(d)(6)).