Rehabilitation Services
Overview
This section provides policy and billing information for outpatient rehabilitation and therapeutic services including physical therapy, occupational therapy, speech-language pathology and audiology.
Eligible Providers
* Comprehensive outpatient rehabilitation facilities (CORF)
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.
** These practitioners do not directly enroll with Minnesota Health Care Programs (MHCP).
Enrollment Information
Audiologists
To enroll with MHCP, audiologists must comply with the requirements of Minnesota Rules, 9505.0195 and must first enroll with Medicare.
A person is eligible to enroll as an audiologist with MHCP if he or she maintains state licensure and completes registration requirements. If the state does not license providers of audiology services, the applicant for enrollment with MHCP must demonstrate that he or she either holds a Certificate of Clinical Compliance in Audiology (CCC-A) from the American Speech-Language-Hearing Association (ASHA) or meets the following clinical practicum standards:
Audiologists who wish to be affiliated with a rehabilitation billing entity must enroll with MHCP.
Refer to the Audiologist Enrollment Criteria and Forms section of the MHCP Provider Manual for details about enrollment requirements.
Occupational therapists (OT)
To enroll with MHCP, occupational therapists must comply with the requirements of Minnesota Rules, 9505.0195 and must first enroll with Medicare.
A person is eligible to enroll with MHCP as an occupational therapist if he or she maintains applicable state licensure or complies with state regulatory requirements in states that do not license.
Refer to the Occupational Therapist Enrollment Criteria and Forms section of the MHCP Provider Manual for more details.
Occupational therapists who wish to affiliate with a rehabilitation billing entity must enroll with MHCP.
Physical therapists (PT)
To enroll with MHCP, physical therapists must comply with the requirements of Minnesota Rules, 9505.0195 and must first enroll with Medicare.
A person is eligible to enroll with MHCP as a physical therapist if he or she maintains applicable state licensure requirements or complies with state regulatory requirements in states that do not license.
Refer to the Physical Therapist Enrollment Criteria and Forms section of the MHCP Provider Manual for more details.
Physical therapists who wish to affiliate 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:
MHCP does not enroll individual therapists employed by rehabilitation agencies. Rehabilitation agencies are responsible to ensure and maintain proper credentialing of therapists they employ.
Refer to the Rehabilitation Agency Enrollment Criteria and Forms section of the MHCP Provider Manual for information about enrolling.
Other rehabilitation group providers
Providers employed and affiliated with a rehabilitation billing entity or physician group are required to enroll as Individual Practitioners with MHCP. This excludes assistants and unqualified personnel.
Speech-language pathologists
To enroll with MHCP, speech-language pathologists must comply with the requirements of Minnesota Rules, 9505.0195 and must first enroll with Medicare.
A person is eligible to enroll as a speech-language pathologist if the person maintains applicable state licensure requirements found in Minnesota Statutes, 148.515 ̶ 148.5175 or complies with state regulatory requirements in states that do not license.
Speech-language pathologists who wish to affiliate with a rehabilitation billing entity must enroll with MHCP.
Refer to the Speech-Language Pathologist Enrollment Criteria and Forms section of the MHCP Provider Manual for details.
Private practice therapists (PPT)
Occupational therapists, physical therapists, speech-language pathologists and audiologists are considered in private practice if they maintain a private office space at their own expense and provide services in that space or in a member’s home. Alternatively, a PPT may be employed by another supplier and furnish services in facilities provided at the expense of that supplier.
A private office is space that the practice leases, owns or rents and uses for the exclusive purpose of operating the practice. For example, a private practice therapy practitioner may not furnish covered services in a skilled nursing facility. If a private practice therapy practitioner wishes to locate his or her private office on-site at a nursing facility, the private office space may not be part of the Medicare-participating skilled nursing facility (SNF) space and the therapist may provide services only within the therapist's private office space.
Private practice also includes therapists who are practicing therapy as employees of another supplier, professional corporation, or other incorporated therapy practice. Private practice does not include individuals when they are working as employees of an institutional provider.
Practitioners with Temporary Licenses or Permits
The following may enroll as MHCP providers if they meet the appropriate requirements in Minnesota Statutes and Rules listed in the Legal References section:
People completing the clinical fellowship year required for certification may provide audiology services or speech-language pathology services under the supervision of a qualified audiologist or speech-language pathologist. Refer to specific requirements regarding supervision during clinical fellowship year.
Speech-language pathologists and audiologists who hold valid temporary licenses must enroll with Medicare before enrolling with MHCP.
Physical therapists with a valid temporary permit to practice and occupational therapists with a valid temporary license to practice may provide services under the supervision of a licensed physical therapist or occupational therapist, but may not enroll as MHCP providers.
Rehabilitation Therapy Assistants
Physical therapist assistants (PTA), occupational therapy assistants (OTA) and speech-language pathology assistants (SLPA) are not eligible to enroll with MHCP. However, MHCP reimburses providers for the supervised services provided by these assistants when delivered under the direction of a qualified enrolled therapist in the respective therapy discipline.
Physical therapist assistants (PTA)
A PTA must meet the following requirements to qualify for reimbursement for providing supervised services:
Supervision of a PTA
A qualified physical therapist must provide on-site observation of the treatment and must document appropriateness of the treatment at least every sixth session when services are provided by a physical therapist assistant. A physical therapist may delegate patient treatment procedures only to a physical therapy assistant who is licensed. 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.
Occupational therapy assistants (OTA)
An OTA must meet the following requirements to qualify for reimbursement for supervised services provided:
Supervision of an OTA
A qualified occupational therapist must determine the frequency and manner of supervision of an occupational therapy assistant performing intervention procedures based on the condition of the patient or client, the complexity of the intervention procedure, and the service competency of the occupational therapy assistant.
Face-to-face collaboration between the occupational therapist and the occupational therapy assistant must occur every 10 intervention days or every 30 days, whichever comes first, during which time the occupational therapist is responsible for:
Face-to-face collaboration must occur more frequently if necessary to meet these requirements.
MHCP will not reimburse for evaluations and reevaluations if provided by occupational therapy assistants.
The occupational therapist must document supervision compliance in the client's file or chart.
Speech-language pathology assistants (SLPA)
A SLPA is a person who meets the requirements under Minnesota Statutes 148.511 to 148.5198 and is licensed by the Minnesota Department of Health (MDH). SLPAs must follow the requirements under Minnesota Statutes, 148.5192 for allowed and prohibited duties.
Supervision of a SLPA
A supervising speech-language pathologist will authorize and accept full responsibility for the performance, practice, and activity of a speech-language pathology assistant. A minimum of one hour every 30 days of consultative supervision time must be documented for each speech-language pathology assistant.
A supervising speech-language pathologist must:
Once every 60 days, the supervising speech-language pathologist must treat or cotreat, with the speech-language pathology assistant, each client on the speech-language pathology assistant's caseload.
A full-time, speech-language pathologist may supervise no more than two full-time, speech-language pathology assistants or the equivalent of two full-time assistants.
Note: Any agency or clinic that intends to utilize the services of a speech-language pathology assistant must provide written notification to the client or, if the client is younger than 18 years old, to the client's parent or guardian before a speech-language pathology assistant may perform any of the duties described in this section.
Eligible Members
Medical Assistance (MA) and MinnesotaCare members are eligible for rehabilitation services.
Covered Services
Refer to the Augmentative Communication Devices manual section for coverage information.
Effective Jan. 1, 2026, MHCP allows up to 14 physical therapy visits per year and up to 24 occupational therapy visits per year, unless authorization for a greater number of visits was obtained.
Rehabilitation and therapy services are subject to post-payment review, which may 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.
Occupational and Physical Therapy Services
To be covered as a rehabilitation and therapeutic service, occupational therapy and physical therapy must be prescribed by a physician or other licensed practitioner of the healing arts and must require the skills of at least one of the following:
Speech-language Pathology and Audiology Services
To be covered as a rehabilitation and therapeutic service, speech-language pathology and audiology services require written referral by a physician or other licensed practitioner of the healing arts, or in the case of a long-term care facility resident, on the written order of a physician. Services must require the skills of at least one of the following:
A plan of treatment must specify treatment. Refer to the Plan of treatment section for more information and requirements.
Comply with Medicare’s site requirements when providing services to Medicare eligible members.
Eligible Ordering and Referring Providers
MHCP recognizes only these MHCP-enrolled providers as valid ordering or referring providers for outpatient OT, PT or SLP services:
Specialized Maintenance Therapy
Specialized maintenance therapy coverage is limited to MHCP members aged 20 and younger. Effective Jan. 1, 2026, MHCP allows up to 14 physical therapy visits per year and up to 24 occupational therapy visits per year, unless authorization for a greater number of visits is obtained. Specialized maintenance therapy is a health service specified in the member’s plan of treatment and certified by a physician, or other licensed practitioner of the healing arts within the practitioner's scope of practice under state law. The therapy must be necessary for maintaining an MHCP member’s functional status at a level consistent with his or her physical or mental limitations and may include treatments in addition to rehabilitation nursing services. MHCP covers specialized maintenance therapy only when provided by any of the following:
Specialized maintenance therapy must be specified in a Plan of treatment that meets the requirements of this section, and provided to members 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:
Telehealth (formerly Telemedicine)
MHCP allows payment for expanded telehealth services, including some rehabilitation services that providers normally conduct face to face. MHCP defines telehealth as the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site.
Conduct telehealth services over a secure, encrypted mode of transmission.
To be eligible for reimbursement, providers must self-attest that they meet all of the conditions of the MHCP telehealth policy by completing the Telehealth Provider Assurance Statement (DHS-6806) (PDF). This includes individually enrolled private-practice therapists and enrolled therapists working within a rehabilitation billing entity that submit claims on the 837P Professional claim type.
Facilities that bill under one National Provider Identifier (NPI) number must have the provider assurance statement signed by a facility administrator or other representative of the organization. This applies to outpatient hospitals or clinics and Medicare-certified rehabilitation agencies that bill on an 837I Institutional claim type.
MHCP allows payment for the following services:
Originating site
The originating site is the location of an eligible MHCP member at the time the service is being furnished via a telecommunication system. Authorized originating sites are any of the following:
Distant site
The distant site is the location of the health care provider at the time the provider is delivering the service to an eligible MHCP member via telecommunication system. There are no specific authorized distant sites or restrictions, but providers must ensure a secure transmission that meets Health Insurance Portability & Accountability Act of 1996 Privacy and Security (HIPAA) requirements.
Eligible rehabilitation providers
The following provider types are eligible to provide telehealth services:
Physical therapy assistants, occupational therapy assistants and speech-language pathology assistants providing services via telehealth must follow the same supervision policy as indicated under Rehabilitation Therapy Assistants.
Refer to the section Practitioners with Temporary License or Permits for information about therapists or assistant therapists with valid temporary permits or licenses who wish to provide telehealth services.
For students, refer to the section Therapy Students Providing Care.
Eligible members
Telehealth coverage applies to MHCP members in fee-for-service programs. Prepaid health plans may choose whether to pay for services delivered in this manner.
Telehealth services
The CPT and HCPCS codes that describe telehealth services are generally the same codes that describe an encounter when the health care provider and patient are at the same site.
Physical and occupational therapists, speech-language pathologists and audiologists may use telehealth to deliver certain covered rehabilitation therapy services that they can appropriately deliver via telehealth. Service delivered by this method must meet all other rehabilitation therapy service requirements and providers must adhere to the same standards and ethics as they would if the service was provided face to face.
Billing telehealth services
MHCP-enrolled providers submit claims for telehealth services using the CPT or HCPCS code that describes the services they provide.
When submitting claims for telehealth services, use place-of-service code 02 to certify that the services meet the telehealth requirements. The GQ modifier is required when billing for services via asynchronous telecommunication systems.
General
In addition to other requirements, refer to the following general telehealth information:
Coverage limitations
The following limitations apply:
MHCP does not cover the following under telehealth:
Documentation requirements for services delivered via telehealth
As a condition of payment, each occurrence of a telehealth service must include the following documentation:
Consultations must meet the criteria defined by Current Procedural Terminology (CPT®).
Documentation Requirements for all Rehabilitation Services
Document all evaluations and reevaluations, services provided, member’s progress, attendance records and discharge plans. Keep documentation in the member’s records. Documentation must demonstrate that rehabilitation and therapeutic services are:
Document rehabilitation and therapeutic services as specified in this section whether MHCP is the primary or secondary payer.
Example: Member 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 member who is dually eligible for Medicare and Medicaid.
Plan of treatment
Provide physical therapy, occupational therapy or speech therapy treatment under a documented plan of treatment, also known as plan of care. When there is an order for services written by a physician or licensed practitioner of the healing arts, the initial plan of treatment certification requirement will be deemed satisfied if the PT/OT/SLP submits the plan of treatment to the member’s referring physician within 30 days of the initial evaluation. Subsequent plans of treatment must be reviewed and revised by an attending physician or licensed practitioner of the healing arts. Refer to Code of Federal Regulations, title 42, section 424.24 for more information.
At minimum, the plan of treatment must specifically state the following:
Authorization Requirements
Effective Jan. 1, 2026, MHCP allows up to 14 physical therapy visits and 24 occupational therapy visits per calendar year without authorization. The provider must obtain authorization when additional visits, including the evaluation, are requested beyond the yearly allowed amount. Refer to information under the General Authorization Criteria and Documentation Requirements headings on the Authorization section of the MHCP Provider Manual to review all general criteria that are required for authorization requests. MHCP does allow retro authorizations.
Authorization documentation must include the following:
Refer to documentation requirements and the authorization process with medical review agent through the medical review agent’s portal specified in the Authorization section of the MHCP Provider Manual.
Therapy students providing care
When appropriate supervision is provided, qualified therapists may bill and be paid for services provided by students of the following if the service would have otherwise been eligible for payment if performed directly by the supervising therapist:
Qualified therapists must follow state licensure requirements for student supervision in addition to these MHCP guidelines. They must use their professional judgment to determine whether a service is billable.
Student: a person in a professional educational program (approved by the appropriate accrediting body) who is satisfying supervised clinical education requirements.
Supervision must be on-site. On-site supervision means the supervising therapist is immediately available in the same building or campus for student instruction. Telecommunication, except within the facility, does not meet the requirement of on-site supervision.
The supervising therapist is responsible for delegating specific duties to the student to establish competency and ensure patient safety. The supervising therapist determines the decision to delegate after establishing proficiency in functions performed by the student and is supported by sufficient academic and clinical preparation.
The supervising therapist is responsible for all functions performed by the student, including completing the documentation or co-signing the student’s 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.
Noncovered Services
The following are not covered under rehabilitation services:
Billing
Refer to the following for billing for rehabilitation services:
Codes and Modifiers
MHCP uses outpatient rehabilitation service codes as defined for CPT or HCPCS, billable in timed units (15 minutes, 30 minutes, 1 hour). Bill outpatient rehabilitation services with codes that most closely describe the service provided.
Refer to these rehabilitation services procedure code charts:
Timed codes
Billing guidelines for duration and number of 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 | |
83 minutes through 97 minutes | 6 | |
98 minutes through 112 minutes | 7 | |
113 minutes through 127 minutes | 8 |
Untimed codes
Refer to the Minnesota Uniform Companion Guides for 837 Health Care Claims for more information.
Modifiers
Use the following modifiers when billing to indicate the therapy discipline delivering the outpatient rehabilitation 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, occupational therapy assistant or speech-language pathology assistant when a physical therapist, occupational therapist or speech-language pathologist under whose supervision the assistant was working was not on the premises. |
59 | Follow the Minnesota 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. |
Telehealth modifiers: GQ | Use to indicate service delivery via telehealth applications. Use to bill only those services that are appropriate for delivery via telehealth: |
Use the correct HCPCS code and appropriate modifier from the Casting & Strapping Services or 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 member 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 members 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.
Rehabilitation Billing Entities
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. Enroll as a Rehabilitation Billing Entity.
Rehabilitation Services Provided in Facility Settings
Rehabilitation Services Provided in a Long-Term Care Facility
Long-term care (LTC) facilities may provide rehabilitation services to both residents and members of the community, using either therapists the LTC employs or those they contract with through an outside vendor, such as a rehab agency or a therapist in private practice.
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 or speech-language pathologist who delegates specific duties to the physical therapy assistant or occupational therapy assistant, monitors the services while the therapy assistant is providing the service, and meets the supervisory requirements of Minnesota Statutes, 148.706 and 148.6432.
Functional status: The ability to carry out the tasks associated with daily living.
Long-term care facility (LTC): Nursing facility (NF), skilled nursing facility (SNF), or intermediate care facility for persons with developmental disabilities (ICF/DD).
Otolaryngologist: A physician specializing in diseases of the ear and larynx who is certified by the American Board of Otolaryngology or eligible for board certification.
Practitioner of the healing arts: For the purposes of this section, a practitioner of the healing arts includes any person who engages in the practice of medicine or surgery, the practice of osteopathy, or a practitioner whose scope of practice under state law includes the diagnosis of disease or health condition and prescribing treatment. For rehabilitation services, these practitioners are limited to physicians, physician assistants, nurse practitioners, podiatrists, dentists, clinical nurse specialists, optometrists and certified nurse midwifes.
Rehabilitation and therapeutic services: Restorative therapy, specialized maintenance therapy and rehabilitation nursing services.
Rehabilitation nursing services: Nursing homes must have an active program of rehabilitation nursing care directed toward helping each resident to achieve and maintain the highest practicable physical, mental and psychosocial well-being according to the comprehensive resident assessment and plan of treatment.
Restorative therapy: A health service specified in the member’s plan of treatment, 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 member’s functional status to a level consistent with the member’s physical or mental limitations.
Specialized maintenance therapy: A health service specified in the member’s plan of treatment and certified by a physician or other licensed practitioner of the healing arts within the practitioner's scope of practice under state law. The physician must certify that the service is designed to maintain a member’s functional status to a level consistent with the member’s physical or mental limitations.
Legal References
Minnesota Statutes, 256B.0625, subdivisions 3(b), 8, 8(a), 8(b), 8(c) and 31(a) (Covered Services)
Minnesota Statutes, 148.514 (General License Requirements SLPs and Audiologists)
Minnesota Statutes, 148.515 (Qualifications for Licensure)
Minnesota Statutes, 148.516 (Licensure by Equivalency)
Minnesota Statutes, 148.5161 (Clinical Fellowship License or Doctoral Externship Licensure)
Minnesota Statutes, 148.517 (Licensure by Reciprocity)
Minnesota Statutes, 148.5175 (Temporary Licensure Speech-language pathologists and Audiologists)
Minnesota Statutes, 148.6410 (Licensure Qualifications for Occupational Therapy Assistants)
Minnesota Statutes, 148.6418 (Occupational Therapists - Temporary Licensure)
Minnesota Statutes, 148.6430 (Occupational Therapists - Delegation of Duties; Assignment of Tasks)
Minnesota Statutes, 148.6432 (Supervision of Occupational Therapy Assistants)
Minnesota Statutes, 148.706 (Physical Therapist Assistants, Aides and Students )
Minnesota Statutes, 148.71 (Physical Therapists - Temporary Permits)
Minnesota Statutes, 148.65 (License requirement for physical therapist assistants)
Minnesota Rules, 4658.0525 (Rehabilitation Nursing Care)
Minnesota Rules, 9505.0175 (Definitions)
Minnesota Rules, 9505.0195 (Provider Participation)
Minnesota Rules, 9505.0210 (Covered Services: General Requirements)
Minnesota Rules, 9505.0220 (Health Services Not Covered by Medical Assistance)
Minnesota Rules, 9505.0385 (Rehabilitation Agency Services)
Minnesota Rules, 9505.0386 (Comprehensive Outpatient Rehabilitation Facilities)
Minnesota Rules, 9505.0390 (Rehabilitation and Therapeutic Services)
Minnesota Rules, 9505.0391 (Therapists Eligible to Enroll as Providers)
Minnesota Rules, 9505.0392 (Compliance With Medicare Requirements)
Minnesota Rules, 9505.0410 (Long-Term Care Facilities; Rehabilitative and Therapeutic Services to Residents)
Minnesota Rules, 9505.0411 (Long-Term Care Facilities; Rehabilitative and Therapeutic Services to Nonresidents)
Minnesota Rules, 9505.0412 (Required Documentation of Rehabilitation and Therapeutic Services)
Minnesota Rules, 9505.5010 (Prior Authorization Requirement)
Code of Federal Regulations, title 42, section 440.110 (Physical Therapists, Occupational Therapists and Services for Individuals with speech, hearing and language disorders)
Code of Federal Regulations, title 42, subpart B, 485.50 ̶ 485.74 (Conditions of Participation: Comprehensive Outpatient Rehabilitation Facilities)
Code of Federal Regulations, title 42, subpart H, sections 485.701 ̶ 485.729 (Conditions of Participation for Clinics, Rehabilitation Agencies and Public Health Agencies)
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