Eli's Rehab Report

Question: For outpatient physical therapy, what is the current requirement for Medicare patients to see their physician during physical therapy? Has it changed from every 30 days?

-- Iowa Subscriberr

Answer: Actually, you are referring to a rule that is no longer valid; patients no longer have to see their physicians during therapy. Therapists used to be required to send Medicare patients to their physicians within 60 days of the start of therapy and then every 30 days thereafter, but on June 6, 2005, CMS eliminated the physician office visit requirement unless the physician requires or requests the visit, or you are doing e-stim or electromagnetic therapy for wound care. If you're doing e-stim for wound care, the patient has to physically go see his doctor every 30 days.

Remember this: An order (sometimes called a referral) for therapy service, if it is documented in the medical record, provides evidence of both the need for care and that the patient is under the care of a physician. True, payment depends on the certification of the plan of care rather than the order, but an order helps determine that a physician is involved in care and available to certify the plan. (The source of this information is in CMS Pub 100-02, Chapter 15, Section 220.1.1.)

-- Reader questions were answered by Rick Gawenda, PT, director of PM&R for Detroit Receiving Hospital and owner of Gawenda Seminars.