Medicare Benefit Policy Manual, Chapter 7 – Home Health Services
Coverage of skilled nursing or therapy to perform a maintenance program does not turn on the presence or absence of a patient’s potential for improvement from the nursing care or therapy, but rather on the patient’s need for skilled care. Skilled care may be necessary to improve a patient’s current condition. To maintain the patient’s current condition, to prevent or slow further deterioration of the patient’s condition.
Section 40.1.1 (Nursing)
… To be considered a skilled service, the service must be so inherently complex that it can be safely and effectively performed only by, or under the supervision of, professional or technical personnel as provided by regulation, including 42 CFR 409.32.
Section 40.2.2E (Therapy)
Where the services that are required to maintain the patient’s current function or to prevent or slow further deterioration are of such complexity and sophistication that the skills of a qualified therapist are required to perform the procedure safely and effectively, the services would be covered physical therapy services. Further, where the particular patient’s special medical complications require the skills of a qualified therapist to perform a therapy service safely and effectively that would otherwise be considered unskilled, such services would be covered physical therapy services. Refer to §40.2.1(d)(3).