Physical Therapy Services

Revised: January 23, 2025

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· Overview

· Authorization

· Eligible Providers

· Supervision and Direction of a PTA

· Covered Services

· Noncovered Services

· Health Records and Documentation

· Billing

· Legal References

Overview

Physical therapy means the evaluation or treatment, or both, of a person by employing physical measures and using therapeutic exercises and rehabilitative procedures with or without assistive devices, for the purpose of preventing, correcting or alleviating a physical or mental disability.

Authorization

The Individualized Education Program (IEP) team authorizes services included in an IEP or Individualized Family Service Plan (IFSP). A physician’s (primary care provider) orders or referral is not required. The licensed physical therapist working within their scope of practice will evaluate services needed, develop the treatment plan and goals or the care plan, treat the patient, or supervise and give direction to a physical therapy assistant (PTA).

Eligible Providers

The following providers can receive reimbursement from Minnesota Health Care Programs (MHCP):

· Physical therapist (PT): A person who is licensed by the State Board of Physical Therapy and meets the requirements in Minnesota Statutes, 148.65-148.78

· Physical therapy assistant (PTA): A person who is licensed by the State Board of Physical Therapy, who is under the direction and supervision of a physical therapist and meets the requirements in Minnesota Statutes

Supervision and Direction of a PTA

Direction means the actions of a PT who:

· Instructs the PTA in specific duties to be performed

· Monitors the provision of services as the PTA provides the service

· Provides on-site observation of the treatment and documentation of its appropriateness at least every sixth treatment session of each child or youth when treatment is provided by a PTA

· Meets all other supervisory requirements

The PT must document supervision and direction.

Covered Services

MHCP covers the following services:

· Individual, group and specialized maintenance therapy provided by a physical therapist or physical therapy assistant under the direction of a physical therapist

· Specialized maintenance therapy provided by a physical therapist or physical therapy assistant that is specified in the child’s IEP or IFSP and is necessary for maintaining a child’s functional status at a level consistent with the child’s physical or mental limitations. Specialized maintenance therapy must meet one of the following: prevent deterioration and sustain function; provide interventions that enable the child to live at their highest level of independence (in the case of chronic or progressive disability); or, provide treatment interventions for children who are progressing, but not at a rate comparable to expectations of restorative care

· Administering face-to-face (in-person or virtual) assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered).

Refer to Covered and Noncovered Services IEP Health-Related Services under the Individualized Education Program Services section in the MHCP Provider Manual for an overview of covered services criteria for all IEP services.

Noncovered Services

Refer to Covered and Noncovered Services IEP Health-Related Services under the Individualized Education Program Services section in the MHCP Provider Manual for an overview of noncovered services that apply to all IEP services.

Health Records and Documentation

Review the Record Keeping and Documentation section for an overview of the basic IEP record keeping, documentation service time and encounter reporting requirements.

Billing

Submit claims using the 837P Professional clam type. Refer to the MN–ITS IEP User Guide for step-by-step instructions for direct data entry claims. Batch billers submitting X12 837P claims, may review the MHCP 5010/D.0 Compliance webpage and the AUC Minnesota Uniform Companion Guide for transaction guideline.

Review the Billing and Authorization section of this guide for general billing requirements.

Legal References

Minnesota Statutes, 148.6404 (Physical Therapist Scope of Practice)
Minnesota Statutes, 256B.0625, subdivision 26 (2013 Covered Services – Special Education)
Minnesota Statutes, 148.706 (Physical Therapist Assistants, Aides, and Students)
Minnesota Rules 9505.0390