This section provides policy and billing information for outpatient rehabilitation and therapeutic services including physical therapy, occupational therapy, speech-language pathology and audiology.
* These practitioners do not directly enroll with Minnesota Health Care Programs (MHCP).
A person is eligible to enroll as an audiologist with MHCP if he or she maintains state licensure and completes registration requirements. If the state does not license providers of audiology services, the applicant for enrollment with MHCP must demonstrate that he or she either holds a Certificate of Clinical Compliance in Audiology (CCC-A) from the American Speech-Language-Hearing Association (ASHA) or meets the following clinical practicum standards:
To enroll with MHCP, audiologists must comply with the requirements of Minnesota Rules and must first enroll with Medicare.
Audiologists who wish to be affiliated with a rehabilitation billing entity must enroll with MHCP.
Comprehensive Outpatient Rehabilitation Facilities (CORFs)
A CORF is a nonresidential facility that is established and operated exclusively to provide diagnostic, therapeutic and restorative services to outpatients for the rehabilitation of injured, disabled or sick people. Services are provided at a single fixed location, by or under the direction of a physician in a facility that meets federal conditions of participation. Additionally, a facility that qualifies as a CORF may enroll to provide mental health services.
Occupational Therapists (OTs)
A person is eligible to enroll with MHCP as an occupational therapist if he or she maintains applicable state licensure or is in compliance with state regulatory requirements in states that do not license.
To enroll with MHCP, occupational therapists must comply with the requirements of Minnesota Rules and must first enroll with Medicare.
Occupational therapists who wish to be affiliated with a rehabilitation billing entity must enroll with MHCP.
Physical Therapists (PTs)
A person is eligible to enroll with MHCP as a physical therapist if he or she meets the following requirements:
To enroll with MHCP, physical therapists must comply with the requirements of Minnesota Rules and must first enroll with Medicare.
Physical therapists who wish to be affiliated with a rehabilitation billing entity must enroll with MHCP.
A rehabilitation agency is a provider certified by Medicare to provide restorative and specialized maintenance therapy in an integrated multidisciplinary rehabilitation program. Services may also include social or vocational adjustment services. Medicare certified rehabilitation agencies must provide services at one of the following:
MHCP does not enroll individual therapists employed by rehabilitation agencies. Rehabilitation agencies are responsible to ensure and maintain proper credentialing of therapists they employ.
Other Rehabilitation Group Providers
Therapists and other health care providers that rehabilitation billing entities and physician groups employ and affiliate with their organization are individually enrolled with MHCP. This excludes assistants as noted earlier and unqualified personnel.
A person is eligible to enroll as a speech-language pathologist if he or she meets the following requirements:
Speech-language pathologists who wish to be affiliated with a rehabilitation billing entity must enroll with MHCP.
To enroll with MHCP, speech-language pathologists must comply with the requirements of Minnesota Rules and must first enroll with Medicare.
Private Practice Therapists (PPT)
Occupational therapists, physical therapists, speech-language pathologists and audiologists are considered in private practice if they maintain a private office space at their own expense and provide services in that space or in a recipient’s home.
Alternatively, a PPT may be employed by another supplier and furnish services in facilities provided at the expense of that supplier.
A private office is space that the practice leases, owns or rents and uses for the exclusive purpose of operating the practice. For example, a private practice therapy practitioner may not furnish covered services in a skilled nursing facility. If a private practice therapy practitioner wishes to locate his or her private office on-site at a nursing facility, the private office space may not be part of the Medicare-participating skilled nursing facility (SNF) space and the therapist may provide services only within the therapist's private office space.
Private practice also includes therapists who are practicing therapy as employees of another supplier, professional corporation or other incorporated therapy practice. Private practice does not include individuals when they are working as employees of an institutional provider.
The following may enroll as an MHCP provider if they meet the appropriate requirements in Minnesota Statutes and Rules listed in the Legal References section:
People completing the clinical fellowship year required for certification may provide audiology services or speech-language pathology services under the supervision of an audiologist or speech-language pathologist. See specific requirements regarding supervision during clinical fellowship year.
Speech-language pathologists and audiologists who hold valid temporary licenses must enroll with Medicare before enrolling with MHCP.
Physical therapists with a valid temporary permit to practice and occupational therapists with a valid temporary license to practice may provide services under the supervision of a licensed physical therapist or occupational therapist, but may not enroll as MHCP providers.
PTAs and OTAs are not eligible to enroll with MHCP. However, MHCP reimburses providers for the supervised services provided by these assistants when delivered under the direction of a qualified enrolled therapist in the respective therapy discipline.
Physical Therapy Assistants (PTA)
PTAs must meet the following requirements:
Supervision of a PTA
A qualified physical therapist must provide on-site observation of the treatment and must document appropriateness of the treatment at least every sixth session when services are provided by a physical therapy assistant. A therapist may delegate patient treatment procedures only to a physical therapy assistant who has sufficient didactic and clinical preparation. The physical therapist may not delegate the following activities to the physical therapy assistant or to other supportive personnel: patient evaluation or reevaluation, treatment planning, initial treatment, change of treatment, and initial or final documentation. A licensed physical therapist may supervise no more than two physical therapy assistants at any time.
Occupational Therapy Assistants (OTA)
OTAs must meet the following requirements:
Supervision of an OTA
A qualified occupational therapist must determine the frequency and manner of supervision of an occupational therapy assistant performing treatment procedures based on the condition of the patient or client, the complexity of the treatment procedure, and the proficiencies of the occupational therapy assistant.
Face-to-face collaboration between the occupational therapist and the occupational therapy assistant must occur, at a minimum, every two weeks, during which time the occupational therapist is responsible for:
Face-to-face collaboration must occur more frequently than every two weeks if necessary to meet these requirements.
MHCP will not reimburse for evaluations and reevaluations if provided by occupational therapy assistants.
The occupational therapist must document supervision compliance in the client's file or chart.
Recipients of Medical Assistance (MA) and MinnesotaCare are eligible for rehabilitation services.
Refer to these Rehabilitation Services Procedure Code Charts:
Refer to the Augmentative Communication Devices manual section for coverage information.
Medical authorization is not required for outpatient rehabilitation and therapeutic services: physical therapy, occupational therapy and speech-language pathology.
Rehabilitation and therapy services are subject to post-payment review, which could result in a provider being required to request authorization for certain services.
Audiology services have an annual threshold. The number of units of service available without authorization renews January 1 of each year.
To be covered as a rehabilitation and therapeutic service, occupational therapy and physical therapy must be prescribed by a physician or other licensed practitioner of the healing arts and must require the skills of at least one of the following:
To be covered as a rehabilitation and therapeutic service, speech-language pathology and audiology services require written referral by a physician or other licensed practitioner of the healing arts, or in the case of a long-term care facility resident, on the written order of a physician. Services must require the skills of at least one of the following:
A Plan of Care must specify treatment. The recipient's attending physician, or other licensed practitioner of the healing arts, must review and revise as medically necessary the plan of care at least once every 90 days (see Plan of Care for additional requirements). MHCP accepts electronic signatures for this requirement.
The physician or other licensed practitioner of the healing arts as defined in this section must expect the recipient’s functional status to progress toward or achieve the objectives in the recipient's plan of care within a 90-day period.
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.
Comply with Medicare’s site requirements when providing services to Medicare eligible recipients.
Effective Jan. 1, 2012, specialized maintenance therapy coverage is limited to MHCP recipients aged 20 and under. Specialized maintenance therapy is a health service specified in the recipient's plan of care and certified by a physician, or other licensed practitioner of the healing arts within the practitioner's scope of practice under state law. The therapy must be necessary for maintaining a recipient's functional status at a level consistent with his or her physical or mental limitations, and may include treatments in addition to rehabilitation nursing services. MHCP covers specialized maintenance therapy only when provided by any of the following:
Specialized maintenance therapy must be specified in a Plan of Care that meets the requirements of this section, and provided to recipients whose condition cannot be maintained or treated through only:
Specialized maintenance therapy must have expected outcomes that are:
Specialized maintenance therapy must meet at least one of the following characteristics:
Effective January 1, 2016, MHCP allows payment for expanded telemedicine services, including some rehabilitation services that are normally conducted face-to-face. Telemedicine is defined as the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site.
Conduct telemedicine services over a secure, encrypted mode of transmission.
To be eligible for reimbursement, providers must self-attest that they meet all of the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for Telemedicine (DHS-6806) (PDF). This includes individually enrolled private-practice therapists and enrolled therapists working within a rehabilitation billing entity that submit claims on the 837P Professional claim type.
Facilities that bill under one NPI number must have the Provider Assurance Statement signed by a facility administrator or other representative of the organization. This applies to outpatient hospitals or clinics and Medicare-certified rehabilitation agencies that bill on an 837I Institutional claim type.
MHCP payment is allowed for the following services:
The originating site is the location of an eligible MHCP recipient at the time the service is being furnished via a telecommunication system. Authorized originating sites are any of the following:
The distant site is the location of the health care provider at the time the provider is delivering the service to an eligible MHCP recipient via telecommunication system. There are no specific authorized distant sites or restrictions, but providers must ensure a secure transmission that meets Health Insurance Portability & Accountability Act of 1996 Privacy & Security (HIPAA) requirements.
Eligible Rehabilitation Providers
The following provider types are eligible to provide telemedicine services:
Physical therapist assistants and occupational therapy assistants providing services via telemedicine must follow the same supervision policy as indicated in “Rehabilitation Service Practitioners”.
Refer to the section Practitioners with Temporary License or Permits for information therapists or assistant therapists with valid temporary permits or licenses who wish to provide telemedicine services.
For students, refer to the section Therapy Students Providing Care.
Telemedicine coverage applies to MHCP recipients in fee-for-service programs. Prepaid health plans may choose whether to pay for services delivered in this manner.
The CPT and HCPCS codes that describe a telemedicine service are generally the same codes that describe an encounter when the health care provider and patient are at the same site.
Physical and occupational therapists, speech-language pathologists and audiologists may use telemedicine to deliver certain covered rehabilitation therapy services that they can appropriately deliver via telemedicine. Service delivered by this method must meet all other rehabilitation therapy service requirements and providers must adhere to the same standards and ethics as they would if the service was provided face-to-face.
Billing Telemedicine Services
MHCP enrolled providers submit claims for telemedicine services using the CPT or HCPCS code that describes the services they provide. Include the following modifiers when submitting claims:
When reporting a service with the GT modifier, you are certifying that you are providing services to a patient located in an eligible originating site via an interactive audio and visual telecommunications system.
In addition to other requirements, refer to the following general telemedicine information:
The following limitations apply:
The following are not covered under telemedicine:
Documentation requirements for services delivered via telemedicine:
As a condition of payment, each occurrence of a telemedicine service must include the following documentation:
Consultations must meet the criteria defined by Current Procedural Terminology (CPT®).
Document all evaluations and re-evaluations, services provided, recipient’s progress, attendance records, and discharge plans. Keep documentation in the recipient's records. Documentation must demonstrate that rehabilitation and therapeutic services are:
Document rehabilitation and therapeutic services as specified in this section whether MHCP is the primary or secondary payer.
Example: Recipient has other third-party insurance. You comply with MHCP documentation standards even if other insurance documentation standards are not the same.
Refer to the professional documentation guidelines for your therapy discipline for guidance on effective documentation:
Refer to the Documentation Requirements for Therapy Services in the Medicare Benefit Policy Manual (PDF) when providing treatment to a recipient who is dually eligible for Medicare and Medicaid.
Plan of Care
Provide rehabilitation and therapeutic services, specialized maintenance therapy and audiology services only under a written Plan of Care (POC). The service(s) must be specified in the recipient’s POC that the recipient’s attending physician or licensed practitioner of the healing arts reviews and revises as medically necessary at least once every 90 days. If the service is to a recipient who is also eligible for Medicare and the service is a Medicare covered service, review the POC in compliance with federal regulations.
The Plan of Care must specifically state the following:
Record of Service
The recipient’s record of service must show the following:
See documentation requirements specified in Authorization.
Therapy Students Providing Care
Only the direct one-to-one patient contact services of the qualified therapist as defined in this section are billable when a student is involved in the delivery of services. MHCP does not reimburse for services a student performs even if the student provides the service under “line of sight” supervision of a qualified therapist. Qualified therapists may bill and be paid for providing services in the following scenarios:
The following are not covered under rehabilitation services:
* These items are considered rehabilitation nursing and are part of the LTC facility per diem payment.
Refer to the following for billing for rehabilitation services:
Codes and Modifiers
MHCP uses outpatient rehabilitation service codes as defined for CPT or HCPCS, billable in timed units (15 minutes, 30 minutes, 1 hour). Bill outpatient rehabilitation services with codes that most closely describe the service provided.
Billing guidelines for duration and number of units
If the duration for each service performed equals:
Bill this number of units:
8 minutes through 22 minutes
Do not bill for services you perform for less than 8 minutes.
23 minutes through 37 minutes
38 minutes through 52 minutes
53 minutes through 67 minutes
68 minutes through 82 minutes
84 minutes through 97 minutes
98 minutes through 112 minutes
113 minutes through 127 minutes
More information is available in the Minnesota Uniform Companion Guides for 837 Health Care Claims.
Use the following modifiers when billing to indicate the therapy discipline delivering the outpatient rehabilitation services:
Required to indicate the service was provided by a physical therapy assistant or occupational therapy assistant when a physical therapist or occupational therapist under whose supervision the assistant was working was not on the premises
Follow the National Correct Coding Initiative (NCCI) instructions for use of the 59 modifier on claims for codes that may not be billed together unless performed on a different anatomic site or represents a different encounter.
Use only to indicate that the therapy service provided was specialized maintenance therapy. Document specialized maintenance therapy in the patient’s record.
Use to indicate service delivery via telemedicine applications. Use to bill only those services that are appropriate for delivery via telemedicine:
Use the correct HCPCS code and appropriate modifier from the Casting & Strapping Services/Supplies chart to bill therapeutic supplies fabricated by the therapist, such as splints, casts and adaptive aids. Do not bill for ready-made or prefabricated supplies that you can get from a medical supplier.
Include the most relevant ICD diagnosis code for the provided service.
Co-therapy: Split the time between therapy disciplines for billing purposes when two or more therapy disciplines deliver services to a recipient in the same block of time. Total time billed should not exceed the actual length of time spent with the patient.
Follow Medicare guidelines for MHCP recipients who are dually eligible for Medicare and Medicaid when providing Medicare covered services.
Bill only for services you provide using your individual NPI number.
Use the organization’s NPI as the pay-to-provider and report the individual NPI of the therapist providing the service as the rendering or treating provider on the claim.
Long-term care facilities may provide rehabilitation services to both residents and members of the community, using either therapists the LTC employs or those they contract with through an outside vendor, such as a rehab agency or a therapist in private practice.
Audiologic Evaluation: An assessment administered by an audiologist or otolaryngologist to evaluate communication problems caused by hearing loss.
Delegation of duties: The actions of a physical or occupational therapist or speech-language pathologist who delegates specific duties to the physical therapy assistant or occupational therapy assistant, monitors the services while the therapy assistant is providing the service, and meets the supervisory requirements of Minnesota Statutes 148.706 and 148.6432 .
Functional Status: The ability to carry out the tasks associated with daily living.
Long-Term Care Facility (LTC): Nursing facility (NF), skilled nursing facility (SNF), or intermediate care facility for persons with developmental disabilities (ICF/DD).
Otolaryngologist: A physician specializing in diseases of the ear and larynx who is certified by the American Board of Otolaryngology or eligible for board certification.
Practitioner of the Healing Arts: For the purposes of this section, practitioner of the healing arts includes any person who engages in, or holds out to the public as being engaged in, the practice of medicine or surgery, the practice of osteopathy, or other practitioner of the healing arts whose scope of practice under state law includes diagnosis of disease or health condition and prescribing treatment; for example, physician assistant, nurse practitioner, podiatrist, oral surgeon, dentist, optometrist.
Rehabilitation and Therapeutic Services: Restorative therapy, specialized maintenance therapy and rehabilitation nursing services.
Rehabilitation Nursing Services: Nursing homes must have an active program of rehabilitation nursing care directed toward helping each resident to achieve and maintain the highest practicable physical, mental and psychosocial well-being according to the comprehensive resident assessment and plan of care. Continuous efforts must be made to encourage ambulation and purposeful activities.
Restorative Therapy: A health service specified in the recipient's plan of care, ordered by a physician or other licensed practitioner of the healing arts within the practitioner's scope of practice under state law, who has certified that the service is designed to restore the recipient's functional status to a level consistent with the recipient's physical or mental limitations.
Specialized Maintenance Therapy: A health service specified in the recipient’s plan of care and certified by a physician or other licensed practitioner of the healing arts within the practitioner's scope of practice under state law that is necessary for maintaining a recipient’s functional status at a level consistent with the recipient’s physical or mental limitations and that may include treatments in addition to rehabilitation nursing services.
Minnesota Statutes 256B.0625 subd. 3b; 8, 8a; 8b; 8c. and subd. 31a. Covered Services
Minnesota Statutes 148.514 General License Requirements SLPs and Audiologists
Minnesota Statutes 148.515 Qualifications for Licensure
Minnesota Statute148.516 Licensure by Equivalency
Minnesota Statute 148.5161 Clinical Fellowship License or Doctoral Externship Licensure
Minnesota Statute 148.517 Licensure by Reciprocity
Minnesota Statutes148.5175 Temporary Licensure Speech-language pathologists and Audiologists
Minnesota Statutes 148.6410 Licensure Qualifications for Occupational Therapy Assistants
Minnesota Statutes 148.6418 Occupational therapists with a temporary license
Minnesota Statutes 148.6430 Occupational Therapists - Delegation of Duties; Assignment of Tasks
Minnesota Statutes148.6432 Supervision of Occupational Therapy Assistants
Minnesota Statutes 148.706 Physical Therapist Assistants, Aides and Students
Minnesota Statutes 148.71 Physical therapists with a temporary permit
Minnesota Statutes 148.65 License requirement for physical therapist assistants
Minnesota Rules 4658.0525 Rehabilitation Nursing Services
Minnesota Rules 9505.0175 Definitions
Minnesota Rules 9505.0195 Provider Participation
Minnesota Rules 9505.0210 Covered Services: General Requirements
Minnesota Rules 9505.0220 Health Services Not Covered by Medical Assistance
Minnesota Rules 9505.0385 Rehabilitation Agency Services
Minnesota Rules 9505.0386 Comprehensive Outpatient Rehabilitation Facilities
Minnesota Rules 9505.0390 Rehabilitation and Therapeutic Services
Minnesota Rules 9505.0391 Therapists Eligible to Enroll as Providers
Minnesota Rules 9505.0392 Compliance With Medicare Requirements
Minnesota Rules 9505.0410 Long-Term Care Facilities; Services to Residents
Minnesota Rules 9505.0411 Long-Term Care Facilities; Services to Non-residents
Minnesota Rules 9505.0412 Required Documentation of Rehabilitation and Therapeutic Services
Minnesota Rules 9505.5010 Prior Authorization
42 CFR 440.110
42 CFR 483.45
42 CFR sub. H, 485.701 to 485.729
42 CFR sub. D, 486.150 to 486.163