Outpatient Maintenance Physical Therapy, Occupational Therapy and Speech Language Pathology Services (Medicare Benefit Policy Manual Ch. 5, §220.2D)
Outpatient Physical Therapy, Occupational Therapy and Speech Language Pathology Services “may be covered [by Medicare] in certain circumstances as maintenance therapy under a maintenance program. The goals of a maintenance program would be, for example, to maintain functional status or to prevent or slow further deterioration.”
“Coverage of therapy services to carry out a maintenance program turns on the beneficiary’s need for skilled care. … skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist are necessary for the performance of safe and effective services in a maintenance program.”
“The deciding factors are always whether the services are considered reasonable, effective treatments for the patient’s condition and require the skills of a therapist.”