Covered Physical Therapy Services

Covered Physical Therapy Services A. The Division of Medicaid covers physical therapy services in the outpatient setting when medically necessary, ordered by a physician, physician assistant or nurse practitioner, and prior authorized by a Utilization Management/Quality Improvement Organization (UM/QIO), the Division of Medicaid or a designated entity to treat a beneficiary’s illness, condition, or injury and the following requirements are met: 1. The services require the knowledge, skill and judgment of a state-licensed physical therapist. 2. The Certificate of Medical Necessity (CMN) for the initial referral/order is completed by the prescribing provider prior to the physical therapy evaluation. 3. The plan of care (POC) is developed by a state-licensed physical therapist. 4. The prescribing provider approves the initial/revised POC with a signature and date: a) Before the initiation of treatment or change in treatment, or b) Within thirty (30) calendar days of the verbal order for the initial treatment plan or change in treatment. 5. The services are rendered as individualized therapy consistent with the symptomatology/diagnosis and do not exceed the beneficiary’s needs. 6. The services do not duplicate another provider’s services including those services provided in a school-based setting. B. The Division of Medicaid reimburses for covered physical therapy services provided by: 1. A state-licensed physical therapist. 2. A state-licensed physical therapist assisted by a state-licensed physical therapist assistant under direct, on-site supervision by a state-licensed physical therapist. a) The Division of Medicaid defines direct, onsite supervision as face-to-face oversight by a state-licensed physical therapist at regular intervals, as prescribed in regulations adopted by the Mississippi State Board of Physical Therapy and does not include: 1) Contacts by telephone, 2) Contacts by pager, 3) Video conferencing, and/or 4) Any method not approved by the Division of Medicaid. b) The initial evaluation, POC, and discharge summary must be completed by a state-licensed physical therapist. 3. A state-licensed physical therapist assisted by a physical therapy student who is enrolled in an accredited physical therapy program while completing the clinical requirements necessary for graduation under direct, on-site supervision of a state-licensed physical therapist, referred to as student assisted physical therapy services. a) The Division of Medicaid defines direct, on-site supervision of a physical therapy student as the face-to-face oversight by a state-licensed physical therapist. b) The state-licensed physical therapist must be physically present and engaged in student oversight during the entirety of a physical therapy session such that the state- licensed physical therapist is considered to be providing the physical therapy service. C. The state-licensed physical therapist cannot supervise at the same time during the work day more than: 1. One (1) physical therapy student, 2. A total of four (4) state-licensed physical therapist assistants, or 3. One (1) physical therapy student and three (3) state-licensed physical therapist assistants.