This section provides policy and billing information for outpatient rehabilitative and therapeutic services including physical therapy, occupational therapy, speech-language pathology and audiology.
* Practitioners not eligible to 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 (CCC) from the American Speech-Language-Hearing Association (ASHA) or meets all 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.
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 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 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.
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:
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:
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.
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:
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:
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 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 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. 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 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:
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:
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:
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:
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 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:
A description of the recipient's progress toward the outcomes for subsequent POC:
The prescribing or ordering physician or licensed practitioner of the healing arts must sign the plan of care.
Record of Service
The recipient’s record of service must show the:
See documentation requirements specified in Authorization.
The following are not covered under rehabilitative services:
* 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.
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 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 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 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.
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 MN 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.
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