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Rehabilitation Therapy Services

Revised: 09-26-2012

  • Eligible Providers
  • Eligible Recipients
  • Authorization Requirements
  • Covered Services
  • Noncovered Services
  • Billing
  • Legal References
  • Rehab Therapies

    Services and interventions specifically designed to improve cognitive functions.

    Eligible Providers

    Therapists must be employed/contracted by a Medicare-Certified Home Health Agency enrolled with MHCP.

    Services may be provided by:

  • • Certified Occupational Therapy Assistant*
  • • Licensed Physical Therapist
  • • Physical Therapy Assistant*
  • • Registered Occupational Therapist
  • • Respiratory Therapy (RT)
  • • Speech Therapy (ST)
  • *Payment is at 65% of therapist rate when the assistant provides the service and the therapist is not on the premises.

    Eligible Recipients

    Recipients must be eligible under one of the following programs:

  • Medical Assistance (MA)
  • MinnesotaCare: Expanded Benefit Set (pregnant women and children under age 21)
  • To qualify for payment, services must be provided to an eligible recipient who is confined to the home or it takes “considerable effort” to depart. The functional status is expected to progress toward or achieve the goals specified in the recipient’s plan of care within a 60-day period.

    Authorization Requirements

    Assessment Requirements

    An assessment is not required for physician ordered, medically necessary rehabilitation therapies.

    Providers are required to document the following in the recipient’s record:

  • • All evaluations
  • • Services provided including:
  • • Date, type and length of each service provided
  • • The name and title of the person(s) providing each service
  • • A statement every 30 days by the therapist indicating the nature, scope, duration and intensity of the therapy are appropriate to the medical condition
  • • Client progress
  • • Discharge plans
  • Authorization is not required for physician ordered, medically necessary rehabilitation therapies.

    Covered Services

    Rehabilitation therapy services are daily, per visit codes, with the exception of Respiratory Therapy which may be provided more than once per day, for services provided in the recipient’s home. All therapies must be specified in the recipient’s plan of care.

    These home care therapy services are not subject to the one-time rehabilitative service thresholds:

    Code

    Type of Therapy

    S9129 TF

    Certified Occupational Therapy Assistant (COTA) services

    S9129

    Occupational Therapy (OT)

    S9131

    Physical Therapy (PT)

    S9131 TF

    Physical Therapy Assistant (PTA) services

    S5181

    Respiratory Therapy (RT)

    S9128

    Speech Therapy (ST)


    If the service is a Medicare covered service, and is provided to a recipient who is eligible for Medicare, the plan of care must be reviewed at the intervals required by Medicare.

    Restorative therapy is:

  • • Specified in the recipient’s plan of care
  • • Ordered by a physician
  • • Designed to restore the recipient’s functional status to a level consistent with the recipient’s physical or mental limitations
  • Specialized maintenance therapy is:

  • • Specified in the recipient’s plan of care
  • • Ordered by a physician
  • • Necessary for maintaining a recipient’s functional status at a level consistent with the recipient’s physical or mental limitations
  • • May include treatments in addition to rehabilitative nursing services
  • Noncovered Services

  • • Rehabilitation services in the home when the recipient can reasonably access these services outside his/her residence, or to a recipient who can leave at will
  • • Rehabilitation provided to a child who could easily be transported, by a parent/guardian to a rehab center
  • Billing

  • • When services are provided by an assistant and the licensed or registered therapist is not on the premises, the services are billed with a modifier, and the payment will be at 65% of the therapist’s rate. The licensed PT or registered OT must provide in-person direction to the assistant at least every sixth visit.
  • • When a home visit is made jointly by the therapist and assistant, the provider may bill only for the therapist’s visit. Providers may not bill for both the PT and PTA (or the OT and COTA) when a joint home visit is made.
  • • When billing for specialized maintenance therapies, use a modifier on your claim, to differentiate these services.
  • Legal References

    MS 256B.0625 subd 8(Covered Services)
    MS 256B.0651
    (Home care services)
    MS 256B.0653
    (Home Health Agencies)
    MN Rule 9505.0295
    (Home Health Services)

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