This section provides policy and billing information for outpatient rehabilitative and therapeutic services including physical therapy, occupational therapy, speech-language pathology, and audiology.
* Practitioner not eligible to enroll with Minnesota Health Care Programs (MHCP).
An individual is eligible to enroll as an audiologist if he/she maintains state licensure and registration requirements. If the state does not license providers of audiology services, the applicant for enrollment with MHCP must demonstrate that he/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:
Audiologists employed by outpatient hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), physician clinics, Medicare certified rehabilitation agencies, IHS or RHCs may enroll with MHCP.
To enroll with MHCP, audiologists must comply with the requirements of MN Rule 9505.0195 and must be enrolled by Medicare.
Comprehensive Outpatient Rehabilitation Facilities (CORFs)
A non-residential facility that is established and operated exclusively to provide diagnostic, therapeutic and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons, at a single fixed location, by or under the direction of a physician and that meets the conditions of participation. Additionally, a facility that qualifies as a CORF may be enrolled to provide mental health services.
Occupational therapists employed by outpatient hospitals, skilled nursing facilities, CORFs, physician clinics, Medicare certified rehabilitation agencies, IHS or RHCs may enroll with MHCP.
To enroll with MHCP, physical therapists must comply with the requirements of MN Rule 9505.0195 and must be enrolled by Medicare.
Physical Therapists (PTs)
An individual is eligible to enroll as a physical therapist if he/she meets the following requirements:
Physical therapists employed by outpatient hospitals, skilled nursing facilities, CORFs, physician clinics, Medicare certified rehabilitation agencies, IHS or RHCs may enroll with MHCP.
To enroll with MHCP, physical therapists must comply with the requirements of MN Rule 9505.0195 and must be enrolled by Medicare.
A provider certified by Medicare to provide restorative, specialized maintenance therapy, and social or vocational adjustment services. Services provided by Medicare certified rehabilitation agencies must be provided at:
MHCP does not require individual therapists employed by rehabilitation agencies to enroll with MHCP. Rehabilitation agencies are responsible to ensure and maintain proper credentialing of therapists employed with their organization.
An individual is eligible to enroll as a speech-language pathologist if they meet the following requirements:
Speech-language pathologists employed by outpatient hospitals, skilled nursing facilities, CORFs, physician clinics, Medicare certified rehabilitation agencies, IHS or RHCs may enroll with MHCP.
To enroll with MHCP, speech-language pathologists must comply with the requirements of MN Rule 9505.0195 and must be enrolled by 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 services are furnished in a recipient’s home. A private office is space that is leased, owned, or rented by the practice and used 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. Therefore, if a private practice therapy practitioner wishes to locate his/her private office on site at a nursing facility, the private office space may not be part of the Medicare participating SNF space and the therapist's services may be furnished only within the therapist's private office space.
Physical Therapist Assistants (PTAs) and Occupational Therapy Assistants (OTAs)
MHCP reimburses providers for the services of a physical therapist assistant or an occupational therapy assistant when services are provided under the supervision of a qualified therapist as indicated below.
Physical Therapist Assistants (PTA):
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 therapist 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 therapist 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 therapist assistants at any time.
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:
Face-to-face collaboration must occur more frequently than every two weeks if necessary to meet the above requirements.
Evaluations and reevaluations will not be reimbursed 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 MN Rule 9505.0390 Subp. 1, item A or L:
Persons 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 per MN Rule 9505.0391.
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/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. Services performed by a student are not reimbursed even if provided under “line of sight” supervision of a qualified therapist. Qualified therapists may bill and be paid for the provision of services in the following scenarios:
Refer to these Rehabilitation Services Procedure Code Charts:
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 now 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 renew January 1 of each year.
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:
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; and must require the skills of at least one of the following:
Treatment must be specified in a Plan of Care that is reviewed and revised as medically necessary by the recipient's attending physician, or other licensed practitioner of the healing arts, at least once every 90 days (see Plan of Care for additional requirements). MHCP accepts electronic signatures for this requirement.
The recipient's functional status must be expected by the physician or other licensed practitioner of the healing arts as defined in this section, 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
Providers must comply with Medicare’s site requirements when services are provided to Medicare eligible recipients.
Effective January 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. Specialized maintenance therapy is covered only when provided by:
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 only through:
Specialized maintenance therapy must have expected outcomes that are:
Specialized maintenance therapy must meet at least one of the following characteristics:
Providers must document all evaluations, and re-evaluations, services provided, recipient’s progress, attendance records, and discharge plans. Documentation must be kept in the recipient's records. Documentation must demonstrate that rehabilitative and therapeutic services are:
Rehabilitative and therapeutic services must be documented as specified in this section whether MHCP is the primary or secondary payer.
Example: Recipient has other third-party insurance. Providers must 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
Rehabilitative and therapeutic services, specialized maintenance therapy and audiology services must be provided under a written Plan of Care (POC). The service(s) must be specified in the recipient’s POC that the 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, the POC must be reviewed in compliance with federal regulations.
The Plan of Care must specifically state:
The Plan of Care must be signed by the prescribing or ordering physician, or licensed practitioner of the healing arts.
Record of Service
The recipient’s record of service must show the:
See documentation requirements specified in Authorization.
* These items are considered rehabilitative nursing and are part of the LTC facility per diem payment.
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.
Do not bill for services represented by 15 minute timed codes when performed for less than 8 minutes on any date of service.
Bill this many units:
If the duration of the service equals:
8 minutes through 22 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
Bill only direct patient contact by the provider as time the patient is treated.
The following modifiers are required when billing to indicate the therapy discipline delivering the outpatient rehabilitative 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 these modifiers to indicate services delivery via telemedicine applications. Only those services that are appropriate for delivery via telemedicine may be billed as such:
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 pre-fabricated supplies that can be obtained 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 services are delivered to a recipient by two or more therapy disciplines 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.
Long-term care facilities may provide rehabilitative services to both residents and members of the community, employing either therapists employed by the LTC or by contracting with an outside vendor such as a rehab agency or 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 who delegates to the physical therapist assistant or occupational therapy assistant in specific duties to be performed, monitors the provision of services, as the therapy assistants provide the service, and meets the supervisory requirements of MN Statutes 148.706 and 148.6432 respectively, when treatment is provided by a physical therapist 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; e.g., 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 active program of rehabilitation nursing care directed toward assisting 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.
MS 256B.0625 subd. 8, 8a; 8b; 8c. and subd. 31a. Covered Services
MS 148.515, subd. 4. Speech-Language Pathology and Audiology Supervision During Fellowship Year
MS 148.5175 Speech-language pathologists and Audiologists who hold a temporary license
MS 148.6410 Licensure Qualifications for Occupational Therapy Assistants
MS 148.6418 Occupational therapists with a temporary license
MS 148.6430 Occupational Therapists - Delegation of Duties; Assignment of Tasks
MS148.6432 Supervision of Occupational Therapy Assistants
MS 148.706 Physical Therapist Assistants, Aides and Students
MS 148.71 Physical therapists with a temporary permit
MS 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