Skip To: Main content|Subnavigation|
Minnesota Department of Human Services Provider Manual
Advanced Search

Rehabilitative Services

Revised: 05-01-2015

  • Overview
  • Eligible Providers
  • Enrollment Requirements
  • Rehabilitation Service Practitioners, Not Eligible to Enroll
  • Eligible Recipients
  • Covered Services
  • Rehabilitation Services Procedure Code Charts
  • Audiology Services
  • Occupational and Physical Therapy Services
  • Speech-language Pathology and Audiology Services
  • Specialized Maintenance Therapy
  • Augmentative Communication Devices
  • Documentation Requirements
  • Noncovered Services
  • Billing
  • Codes and Modifiers
  • Therapists in Private Practice
  • Rehabilitation Services Provided in Facility Settings
  • Rehabilitation Services Provided in a Long-Term Care Facility
  • Definitions
  • Legal References
  • Overview

    This section provides policy and billing information for outpatient rehabilitative and therapeutic services including physical therapy, occupational therapy, speech-language pathology and audiology.

    Eligible Providers

  • • Audiologists
  • • Comprehensive Outpatient Rehabilitation Facilities (CORFs)
  • • Indian Health Services (IHS)
  • • Long term care facilities
  • • Medicare certified rehabilitation agencies
  • • Occupational therapists
  • • *Occupational therapy assistants
  • • Outpatient hospitals
  • • Physical therapists
  • • *Physical therapist assistants
  • • Rehab billing entities
  • • Rural Health Clinics (RHCs)
  • • Speech-language pathologists
  • * Practitioners not eligible to enroll with Minnesota Health Care Programs (MHCP).

    Enrollment Requirements

    Audiologists
    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 (CCC) from the American Speech-Language-Hearing Association (ASHA) or meets all the following clinical practicum standards:

  • • Has demonstrated successful completion of a minimum of 350 clock-hours of supervised clinical practicum (or is in the process of accumulating that supervised experience)
  • • Has performed not less than nine months of supervised full-time audiology services after obtaining a master’s or doctoral degree in audiology
  • • Has successfully completed a national exam in audiology approved by the Secretary
  • 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:

  • • Maintains applicable state licensure requirements or is in compliance with state regulatory requirements in states that do not license
  • • Graduated after successful completion of a physical therapy education program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), or its equivalent
  • • Passed an examination for physical therapists approved by the State in which the physical therapy services are provided
  • 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.

    Rehabilitation Agencies
    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:

  • • A site surveyed by the Minnesota Department of Health and certified according to Medicare standards
  • • A site that meets State Fire Marshall standards, as documented in the providers' records
  • • The recipient's residence
  • 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.

    Speech-Language Pathologists
    A person is eligible to enroll as a speech-language pathologist if he or she meets the following requirements:

  • • Maintains applicable state licensure requirements or is in compliance with state regulatory requirements in states that do not license
  • • Has a Certificate of Clinical Competence in speech-language pathology from the American Speech-Language-Hearing Association, or is completing the clinical fellowship year required for certification as a speech-language pathologist
  • 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.

    Therapists in Private Practice
    Occupational therapists, physical therapists, speech-language pathologists and audiologists who are in private practice must maintain a private office even if they provide services in a recipient’s home. 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.

    Rehabilitative Service Practitioners Not Eligible to Enroll

    Physical Therapist Assistants (PTAs) and Occupational Therapy Assistants (OTAs)
    MHCP reimburses providers for the services of a physical therapy assistant or an occupational therapy assistant when services are provided under the supervision of a qualified therapist as indicated below.

    Physical Therapy Assistants (PTA)
    PTAs must meet the following requirements:

  • • Have successfully completed all academic and field work requirements of a physical therapy assistant program accredited by the Commission on Accreditation in Physical Therapy Education
  • • Maintain state licensure requirements or be in compliance with state regulatory requirements in states that do not license physical therapist assistants
  • Supervision of a PTA
    A qualified physical therapist must provide on-site observation of the treatment and documentation of its appropriateness at least every sixth treatment 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:

  • • Be certified by the National Board for Certification of Occupational Therapy as an occupational therapy assistant
  • • Maintain applicable state licensure requirements or be in compliance with state regulatory requirements in states that do not license occupational therapy assistants
  • Supervision of an OTA
    An 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:

  • • Planning and documenting an initial treatment plan and discharge from treatment
  • • Reviewing treatment goals, therapy programs and client progress
  • • Supervising changes in the treatment plan
  • • Conducting or observing treatment procedures for selected clients and documenting appropriateness of treatment procedures. Clients will be selected based on the occupational therapy services provided to the client and the role of the occupational therapist and the occupational therapy assistant in those services
  • • Ensuring the service competency of the occupational therapy assistant in performing delegated treatment procedures
  • Face-to-face collaboration must occur more frequently than every two weeks if necessary to meet the above 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.

    Practitioners with Temporary License
    The following may enroll as an MHCP provider if they meet the requirements in Minnesota Rules:

  • • Speech-language pathologists or audiologists who hold a temporary license (up to 90 days)
  • • Speech-language pathologists or audiologists with a temporary clinical fellowship license or doctoral externship license (up to 180 days)
  • 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 also be actively enrolled 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.

    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:

  • • A qualified therapist is present and in the room for the entire session. The student participates in the delivery of services when the qualified therapist is directing the treatment, making the skilled judgment, and taking responsibility for the assessment and treatment.
  • • A qualified therapist is present in the room guiding the student in service delivery when the therapy student is participating in providing services, and the therapist is not engaged in treating another patient or doing other tasks at the same time. Documentation of the therapy service must clearly indicate the qualified therapist was present in the room, guiding the student in the delivery of the service(s) and not simply “on the premises.” The focus of the therapist must be on the services the student is providing and not on other activities or other patients.
  • • The student may complete the documentation as part of his or her education or hands-on training, but the qualified therapist is responsible for the delivery of services and the documentation and must sign all the documentation. In signing the documentation, the therapist indicates he or she has read it and is responsible for its contents. Documentation must clearly indicate the student provided the services under the therapist’s direction. The student may also sign the documentation but it is not required for payment.
  • Eligible Recipients

    Recipients of:

  • • Medical Assistance (MA)
  • • MinnesotaCare
  • Covered Services

    Refer to these Rehabilitation Services Procedure Code Charts:

  • Audiology Services
  • Occupational Therapy, Physical Therapy, Speech-Language Pathology Services
  • Casting, Strapping Services and Supplies
  • Orthotic Procedures (L-codes)
  • Refer to the Augmentative Communication Devices manual section for coverage information.

    Effective July 1, 2013, medical authorization is no longer required for outpatient rehabilitative and therapeutic services: physical therapy, occupational therapy and speech-language pathology. Authorization requirements were suspended for service dates July 1, 2011, through June 30, 2013.

    Rehabilitative 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

    Audiology services have an annual threshold. The number of units of service available without authorization renews January 1 of each year.

  • • Recipients may require a greater number of evaluations, modalities or procedures than are available in the annual service threshold. Recipients may receive additional medically necessary services with authorization.
  • • Medicare crossover claims for coinsurance and deductible do not debit against the audiology annual thresholds.
  • • Third-party liability (TPL) claims submitted to MHCP for payment debit against the audiology annual thresholds. If you are aware the TPL payment will equal or exceed the MHCP payment, you may consider not billing MHCP because all claims debit against the threshold, even if the claim pays zero dollars.
  • Occupational and Physical Therapy Services

    To be covered as a rehabilitative 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:

  • • A physical therapist
  • • An occupational therapist
  • • A physical therapy assistant who is working under the supervision of a physical therapist
  • • An occupational therapy assistant working under the supervision of an occupational therapist
  • Speech-language Pathology and Audiology Services

    To be covered as a rehabilitative 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 speech-language pathologist
  • • An audiologist
  • • A person completing the clinical fellowship year required for certification as a speech-language pathologist
  • • A person completing the clinical fellowship year required for certification as an audiologist and working under the supervision of an audiologist
  • 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.

    Specialized Maintenance Therapy

    Effective Jan. 1, 2012, specialized maintenance therapy coverage is limited to MHCP recipients age 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, 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 rehabilitative nursing services. MHCP covers specialized maintenance therapy only when provided by:

  • • A physical therapist
  • • A physical therapy assistant
  • • An occupational therapist
  • • An occupational therapy assistant
  • • A speech-language pathologist
  • 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:

  • • Rehabilitative nursing services
  • • Services of other care providers
  • • The recipient, because the recipient's physical, cognitive or psychological deficits result in:
  • • Spasticity or severe contracture that interferes with the activities of daily living or with completing routine nursing care, or that has resulted in decreased functional ability compared to the recipient's previous level of function
  • • A chronic condition that results in physiological deterioration and that requires specialized maintenance therapy services or equipment to maintain strength, range of motion, endurance, movement patterns (functional mobility such as gait, transfers, ambulation, bed or chair mobility), activities of daily living, cardiovascular function, integumentary status, or positioning necessary for completing the recipient's activities of daily living, or decreased abilities relevant to the recipient's current environmental demands
  • Specialized maintenance therapy must have expected outcomes that are:

  • • Functional
  • • Realistic
  • • Relevant
  • • Transferable to the recipient's current or anticipated environment, such as home, school, community, work
  • • Consistent with community standards
  • Specialized maintenance therapy must meet at least one of the following characteristics:

  • • Prevent deterioration and sustain function
  • • Provide interventions, in the case of a chronic or progressive disability, that enable the recipient to live at the recipient's highest level of independence
  • • Provide treatment interventions for recipients who are progressing but not at a rate comparable to the expectations of restorative care
  • Documentation Requirements

    Providers must 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 rehabilitative and therapeutic services are:

  • • Medically necessary as determined by prevailing community standards or customary practice and usage
  • • Appropriate and effective for the recipient’s medical needs
  • • Timely, considering the nature and present medical condition of the recipient
  • • Provided by a provider with appropriate credential
  • • The least expensive, appropriate alternative available
  • • An effective and appropriate use of MHCP funds
  • Document rehabilitative 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:

  • Guidelines for Documentation of Occupational Therapy (PDF)
  • Guidelines: Physical Therapy Documentation of Patient/Client Management (PDF)
  • Clinical Record Keeping in Speech-Language Pathology for Health Care and Third Party Payers (PDF)
  • 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 rehabilitative 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:

  • • The recipient’s medical and treatment diagnosis and any contraindications to treatment
  • • A description of the recipient’s functional status or limitations
  • • The objectives of the rehabilitative and therapeutic service
  • • A description of the recipient’s progress toward the objectives
  • • The treatment plan, including interventions to be provided
  • • Outcomes of the rehabilitative and therapeutic service, which include treatment goals that are:
  • • Functional
  • • Measurable
  • • Time-specific
  • • Projected frequency and duration of treatment
  • • Plans for discharge from treatment
  • A description of the recipient's progress toward the outcomes for subsequent POC:

  • • Home program teaching
  • • Collaboration with other professionals and services
  • • Progress toward goals with updating as indicated
  • • Modifications to the initial plan of care
  • • Plans for continuing care
  • Record of Service
    The recipient’s record of service must show the:

  • • Date, type, length and scope of each service
  • • Name and title of each person providing the service
  • • Name and title of each person supervising or directing the care
  • • Documented evidence of progress at least every 30 days by the therapist providing or supervising the services that shows the therapy's nature, scope, duration and intensity are appropriate to the medical condition of the recipient
  • See documentation requirements specified in Authorization.

    Noncovered Services

    The following are not covered under rehabilitative services:

  • • Physical or occupational therapy that is provided without an order from a physician or other licensed practitioner of the healing arts
  • • Speech-language or audiology services provided without a written referral from a physician or other licensed practitioner of the healing arts
  • • Services for physical or occupational therapy provided by a person who was issued a temporary permit for physical therapy or a temporary license for occupational therapy and the temporary permit or license has expired
  • • Services for speech-language pathology or audiology services provided by a person whose temporary license has expired
  • • Services for contracture that are not severe and do not interfere with the recipient's functional status or with completing nursing care as required for licensure of the LTC facility
  • • Ambulation of a recipient who has an established functional gait pattern
  • • Services for conditions of chronic pain that do not interfere with the recipient's functional status and that can be treated by routine nursing measures
  • • Services for activities of daily living when performed by the therapist, therapy assistant or therapy aide
  • • Bowel and bladder retraining programs
  • • Specialized maintenance therapy for MHCP recipients age 21 and over (effective January 1, 2012)
  • • Art and craft activities for the purpose of recreation
  • • Services that are not:
  • • Medically necessary
  • • Documented in the recipient's health care record
  • • Part of the recipient's plan of care
  • • Designed to improve or maintain the functional status of a recipient with a physical impairment or a cognitive or psychological deficit
  • • Services specified in a plan of care that is not reviewed and revised as medically necessary by the recipient’s attending physician or practitioner of the healing arts as defined in this section
  • • Services by more than one provider of the same type for the same diagnosis unless the school district provides the service as specified in the recipient's IEP
  • • A rehabilitative and therapeutic service for which Medicare denies payment because of the provider's failure to comply with Medicare requirements
  • • Vocational or educational services, including functional capacity evaluations, except as provided under IEP-related services
  • • Services provided by a therapy aide or therapy student (see Therapy Students Providing Care)
  • • Psychosocial services
  • • Record keeping, documentation and travel time (the transport and waiting time of a recipient to and from therapy sessions)
  • • Services provided by a rehabilitation agency that take place in a sheltered workshop, Day Training and Habilitation center (DT&H), Day Activity Center (DAC), or a residential or group home that is an affiliate of the rehabilitation agency
  • • *Yearly assessments of LTC residents to meet OBRA regulations
  • • Training or consultation that an audiologist provides to an agency, facility or other institution
  • * These items are considered rehabilitative nursing and are part of the LTC facility per diem payment.

    Billing

  • • Bill using MN–ITS Interactive 837P or 837I
  • • Refer to the Rehab (837P) Professional MN–ITS User Guide or the Outpatient Rehab (837I) MN–ITS User Guide for instructions
  • • X12 Batch users: Refer to Minnesota Uniform Companion Guide and Best Practices for billing instructions
  • • Enter the NPI of the referring or ordering physician or other practitioner of the healing arts on claims for OT, PT, SLP and audiology. Referring or ordering physicians must be enrolled with MHCP
  • Codes and Modifiers

    MHCP uses outpatient rehabilitative service codes as defined in CPT/HCPCS billable in timed units (15 minutes, 30 minutes, 1 hour). Bill outpatient rehabilitative services with codes that most closely describe the service provided.

  • • Timed Codes
  • • Do not bill for services represented by 15-minute timed codes when performed for less than 8 minutes on any date of service
  • • Follow billing guidelines in the table below only for services spent directly with the recipient
  • • Bill only direct patient contact by the provider as time the patient is treated
  • • Do not follow Medicare’s rounding rules for speech, occupational, and physical therapy services. Each modality and unit(s) is reported separately by code definition. Do not combine codes to determine total time units.

    If the duration for each service performed equals:

    Bill this number of units:

    Notes:

    8 minutes through 22 minutes

    1

    Do not bill for services you perform for less than 8 minutes.



    If a service represented by a 15-minute timed code is performed in a single day for at least 8 and through 22 minutes, bill that service as one unit. If you perform the same service for at least 23 minutes, bill that service for at least two units, etc.



    Billable units are not determined by total session time.

    23 minutes through 37 minutes

    2

    38 minutes through 52 minutes

    3

    53 minutes through 67 minutes

    4

    68 minutes through 82 minutes

    5

    84 minutes through 97 minutes

    6

    98 minutes through 112 minutes

    7

    113 minutes through 127 minutes

    8

    Untimed Codes

  • • Bill CPT or HCPCS codes that do not have a timed component or unit assigned as one unit per visit, regardless of the time spent during the session
  • • Bill only one unit for any date of service that is a “per visit/session” code
  • More information is available in the Minnesota Uniform Companion Guides for 837 Health Care Claims.

    Modifiers
    Use the following modifiers when billing to indicate the therapy discipline delivering the outpatient rehabilitative services:

    Modifier table

    Modifier

    Description

    GN

    Speech-language pathology

    GO

    Occupational therapy

    GP

    Physical therapy

    U7

    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

    59

    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.

    UC

    Use only to indicate that the therapy service provided was specialized maintenance therapy. Document specialized maintenance therapy in the patient’s record.

    Telemedicine modifiers:

    GQ


    GT

    Use to indicate service delivery via telemedicine applications. Use to bill only those services that are appropriate for delivery via telemedicine:

  • • Services delivered via asynchronous telecommunications system (via computer)
  • • Services delivered via interactive audio and video telecommunication system
  • 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.

    Therapists in Private Practice

    Bill only for services you provide using your individual NPI number.

    Rehab Billing Entity

    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.

    Rehabilitative Services Provided in Facility Settings

  • • Enter the NPI of the facility (physician clinic, outpatient hospital, rehabilitation agency, or CORF) as the pay-to-provider when billing rehabilitative services provided in these settings
  • • The pay-to-provider’s NPI and the rendering/treating provider’s NPI must be the same on the claim; do not enter an individual therapist’s NPI as the rendering/treating provider when billing for services provided in these types of facilities
  • Rehabilitative Services Provided in an LTC Facility

    Long-term care facilities may provide rehabilitative 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.

  • • Therapists must provide services on the LTC premises
  • • Rehabilitative services included in the LTC per diem rate may not be billed as an outpatient service
  • • LTC facilities located in Minnesota no longer include rehabilitative services in their per diem
  • • Bill services provided to recipients who are also eligible for Medicare following Medicare’s requirements
  • • The LTC facility must bill for services provided by its employees
  • • Either the vendor or the LTC facility may bill for services provided by contracted outside vendors; however, the provider billing for and receiving payment for services is responsible for the accuracy of the claims and for maintaining patient records that fully disclose the extent of the benefits provided
  • • The pay-to provider’s NPI and the rendering or treating provider’s NPI must be the same on the claim; do not enter the therapist’s NPI as the rendering or treating provider when billing for services provided in a nursing home
  • Definitions

    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 who delegates to the physical therapy assistant or occupational therapy assistant in specific duties to be performed, monitors the services the assistant provides while the therapy assistant provides the service, and meets the supervisory requirements of Minnesota Statutes 148.706 and 148.6432 respectively, when treatment is provided by a physical therapy assistant or occupational therapy assistant.

    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.

    Rehabilitative and Therapeutic Services: Restorative therapy, specialized maintenance therapy and rehabilitative nursing services.

    Rehabilitative 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 rehabilitative nursing services.

    Legal References

    Minnesota Statutes 256B.0625 subd. 8, 8a; 8b; 8c. and subd. 31a. Covered Services
    Minnesota Statutes 148.515
    , subd. 4. Speech-Language Pathology and Audiology Supervision During Fellowship Year
    Minnesota Statutes 148.5175
    Speech-language pathologists and Audiologists who hold a temporary license
    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
    Rehabilitative 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
    Rehabilitative 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 Rehabilitative 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

    Rate/Report this page Report/Rate this page

    © 2015 Minnesota Department of Human Services
    Minnesota.gov is led by MN.IT Services
    Updated: 5/11/15 1:33 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 5/11/15 1:33 PM
    ent who is dually eligible for Medicare and Medicaid.

    Plan of Care
    Provide rehabilitative 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:

  • • The recipient’s medical and treatment diagnosis and any contraindications to treatment
  • • A description of the recipient’s functional status or limitations
  • • The objectives of the rehabilitative and therapeutic service
  • • A description of the recipient’s progress toward the objectives
  • • The treatment plan, including interventions to be provided
  • • Outcomes of the rehabilitative and therapeutic service, which include treatment goals that are:
  • • Functional
  • • Measurable
  • • Time-specific
  • • Projected frequency and duration of treatment
  • • Plans for discharge from treatment
  • A description of the recipient's progress toward the outcomes for subsequent POC:

  • • Home program teaching
  • • Collaboration with other professionals and services
  • • Progress toward goals with updating as indicated
  • • Modifications to the initial plan of care
  • • Plans for continuing care
  • Record of Service
    The recipient’s record of service must show the:

  • • Date, type, length and scope of each service
  • • Name and title of each person providing the service
  • • Name and title of each person supervising or directing the care
  • • Documented evidence of progress at least every 30 days by the therapist providing or supervising the services that shows the therapy's nature, scope, duration and intensity are appropriate to the medical condition of the recipient
  • See documentation requirements specified in Authorization.

    Noncovered Services

    The following are not covered under rehabilitative services:

  • • Physical or occupational therapy that is provided without an order from a physician or other licensed practitioner of the healing arts
  • • Speech-language or audiology services provided without a written referral from a physician or other licensed practitioner of the healing arts
  • • Services for physical or occupational therapy provided by a person who was issued a temporary permit for physical therapy or a temporary license for occupational therapy and the temporary permit or license has expired
  • • Services for speech-language pathology or audiology services provided by a person whose temporary license has expired
  • • Services for contracture that are not severe and do not interfere with the recipient's functional status or with completing nursing care as required for licensure of the LTC facility
  • • Ambulation of a recipient who has an established functional gait pattern
  • • Services for conditions of chronic pain that do not interfere with the recipient's functional status and that can be treated by routine nursing measures
  • • Services for activities of daily living when performed by the therapist, therapy assistant or therapy aide
  • • Bowel and bladder retraining programs
  • • Specialized maintenance therapy for MHCP recipients age 21 and over (effective January 1, 2012)
  • • Art and craft activities for the purpose of recreation
  • • Services that are not:
  • • Medically necessary
  • • Documented in the recipient's health care record
  • • Part of the recipient's plan of care
  • • Designed to improve or maintain the functional status of a recipient with a physical impairment or a cognitive or psychological deficit
  • • Services specified in a plan of care that is not reviewed and revised as medically necessary by the recipient’s attending physician or practitioner of the healing arts as defined in this section
  • • Services by more than one provider of the same type for the same diagnosis unless the school district provides the service as specified in the recipient's IEP
  • • A rehabilitative and therapeutic service for which Medicare denies payment because of the provider's failure to comply with Medicare requirements
  • • Vocational or educational services, including functional capacity evaluations, except as provided under IEP-related services
  • • Services provided by a therapy aide or therapy student (see Therapy Students Providing Care)
  • • Psychosocial services
  • • Record keeping, documentation and travel time (the transport and waiting time of a recipient to and from therapy sessions)
  • • Services provided by a rehabilitation agency that take place in a sheltered workshop, Day Training and Habilitation center (DT&H), Day Activity Center (DAC), or a residential or group home that is an affiliate of the rehabilitation agency
  • • *Yearly assessments of LTC residents to meet OBRA regulations
  • • Training or consultation that an audiologist provides to an agency, facility or other institution
  • * These items are considered rehabilitative nursing and are part of the LTC facility per diem payment.

    Billing

  • • Bill using MN–ITS Interactive 837P or 837I
  • • Refer to the Rehab (837P) Professional MN–ITS User Guide or the Outpatient Rehab (837I) MN–ITS User Guide for instructions
  • • X12 Batch users: Refer to Minnesota Uniform Companion Guide and Best Practices for billing instructions
  • • Enter the NPI of the referring or ordering physician or other practitioner of the healing arts on claims for OT, PT, SLP and audiology. Referring or ordering physicians must be enrolled with MHCP
  • Codes and Modifiers

    MHCP uses outpatient rehabilitative service codes as defined in CPT/HCPCS billable in timed units (15 minutes, 30 minutes, 1 hour). Bill outpatient rehabilitative services with codes that most closely describe the service provided.

  • • Timed Codes
  • • Do not bill for services represented by 15-minute timed codes when performed for less than 8 minutes on any date of service
  • • Follow billing guidelines in the table below only for services spent directly with the recipient
  • • Bill only direct patient contact by the provider as time the patient is treated
  • • Do not follow Medicare’s rounding rules for speech, occupational, and physical therapy services. Each modality and unit(s) is reported separately by code definition. Do not combine codes to determine total time units.

    If the duration for each service performed equals:

    Bill this number of units:

    Notes:

    8 minutes through 22 minutes

    1

    Do not bill for services you perform for less than 8 minutes.



    If a service represented by a 15-minute timed code is performed in a single day for at least 8 and through 22 minutes, bill that service as one unit. If you perform the same service for at least 23 minutes, bill that service for at least two units, etc.



    Billable units are not determined by total session time.

    23 minutes through 37 minutes

    2

    38 minutes through 52 minutes

    3

    53 minutes through 67 minutes

    4

    68 minutes through 82 minutes

    5

    84 minutes through 97 minutes

    6

    98 minutes through 112 minutes

    7

    113 minutes through 127 minutes

    8

    Untimed Codes

  • • Bill CPT or HCPCS codes that do not have a timed component or unit assigned as one unit per visit, regardless of the time spent during the session
  • • Bill only one unit for any date of service that is a “per visit/session” code
  • More information is available in the Minnesota Uniform Companion Guides for 837 Health Care Claims.

    Modifiers
    Use the following modifiers when billing to indicate the therapy discipline delivering the outpatient rehabilitative services:

    Modifier table

    Modifier

    Description

    GN

    Speech-language pathology

    GO

    Occupational therapy

    GP

    Physical therapy

    U7

    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

    59

    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.

    UC

    Use only to indicate that the therapy service provided was specialized maintenance therapy. Document specialized maintenance therapy in the patient’s record.

    Telemedicine modifiers:

    GQ


    GT

    Use to indicate service delivery via telemedicine applications. Use to bill only those services that are appropriate for delivery via telemedicine:

  • • Services delivered via asynchronous telecommunications system (via computer)
  • • Services delivered via interactive audio and video telecommunication system
  • 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.

    Therapists in Private Practice

    Bill only for services you provide using your individual NPI number.

    Rehab Billing Entity

    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.

    Rehabilitative Services Provided in Facility Settings

  • • Enter the NPI of the facility (physician clinic, outpatient hospital, rehabilitation agency, or CORF) as the pay-to-provider when billing rehabilitative services provided in these settings
  • • The pay-to-provider’s NPI and the rendering/treating provider’s NPI must be the same on the claim; do not enter an individual therapist’s NPI as the rendering/treating provider when billing for services provided in these types of facilities
  • Rehabilitative Services Provided in an LTC Facility

    Long-term care facilities may provide rehabilitative 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.

  • • Therapists must provide services on the LTC premises
  • • Rehabilitative services included in the LTC per diem rate may not be billed as an outpatient service
  • • LTC facilities located in Minnesota no longer include rehabilitative services in their per diem
  • • Bill services provided to recipients who are also eligible for Medicare following Medicare’s requirements
  • • The LTC facility must bill for services provided by its employees
  • • Either the vendor or the LTC facility may bill for services provided by contracted outside vendors; however, the provider billing for and receiving payment for services is responsible for the accuracy of the claims and for maintaining patient records that fully disclose the extent of the benefits provided
  • • The pay-to provider’s NPI and the rendering or treating provider’s NPI must be the same on the claim; do not enter the therapist’s NPI as the rendering or treating provider when billing for services provided in a nursing home
  • Definitions

    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 who delegates to the physical therapy assistant or occupational therapy assistant in specific duties to be performed, monitors the services the assistant provides while the therapy assistant provides the service, and meets the supervisory requirements of Minnesota Statutes 148.706 and 148.6432 respectively, when treatment is provided by a physical therapy assistant or occupational therapy assistant.

    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.

    Rehabilitative and Therapeutic Services: Restorative therapy, specialized maintenance therapy and rehabilitative nursing services.

    Rehabilitative 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 rehabilitative nursing services.

    Legal References

    Minnesota Statutes 256B.0625 subd. 8, 8a; 8b; 8c. and subd. 31a. Covered Services
    Minnesota Statutes 148.515
    , subd. 4. Speech-Language Pathology and Audiology Supervision During Fellowship Year
    Minnesota Statutes 148.5175
    Speech-language pathologists and Audiologists who hold a temporary license
    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
    Rehabilitative 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
    Rehabilitative 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 Rehabilitative 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

    Rate/Report this page Report/Rate this page

    © 2015 Minnesota Department of Human Services
    Minnesota.gov is led by MN.IT Services
    Updated: 5/11/15 1:33 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 5/11/15 1:33 PM