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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Welcome to Therapy Comply's Medicare page.  Here we have detailed information on the coverage of physical, occupational, and speech therapy services under the Medicare program.  Members have full access to the material and can also contact us with questions regarding any billing or compliance issue, please consider joining today if you need assistance.  

Medicare FAQs

    • Frequently asked questions on Medicare coverage of therapy services

Medicare Enrollment

    • Occupational Therapists 
    • Physical Therapists 
    • Speech Therapists
    • Site Visits for Physical Therapy Practices
    • Effective Enrollment Date and Retroactive Billing

Criteria for Outpatient Coverage

    • Criteria for Coverage
    • Medical Necessity
    • Rehabilitative Therapy
    • Maintenance Therapy
    • Role of the Physician/NPP
    • The Practice of PT, OT, and SLP

Therapy Services

    • National Coverage Determinations
    • Therapeutic Procedures
    • Modalities
    • DME: Prosthetics and Orthotics
    • Casting and Strapping
    • Speech Therapy
    • Limitations and Non-Covered Services
Telehealth (Covid-19)
    • Codes Allowed for Telehealth
    • Rules for Medicare Telehealth

    Medicare Appeals

      • Levels of Appeals and Time Limits for Filing
      • Good Cause for Late Filing
      • Decisions Subject to Appeal
      • Who may File an Appeal
      • Representatives - Representing your patient
      • Levels of Appeals
      • Medicare Advantage Appeals

    Merit-Based Incentive Payment System (MIPS)

      • Eligibility Criteria
      • Quality Measures of PT and OT
      • Improvement Activities 

    Polices and Procedures

    Documentation Requirements for Therapy Services

      • General Requirements
      • Evaluations and Re-Evaluations
      • Plan of Care
      • Certification and Re-Certification of the POC
      • Progress Reports 
      • Treatment Notes 
      • Discharge Summaries

    Assistive Personnel

      • Supervision Levels for Assistants
      • CO/CQ Modifiers
      • Students
      • Aides

    Billing and Coding

      • 8-Minute/Total Time Rule
      • KX Modifier and Targeted Review
      • Utilization Guidelines
      • Multiple Payment Procedure Reductions (MPPR)
      • Qualified Medicare Beneficiaries (QMB)
      • Secondary Payer 
      • ICD-10 Codes

    Practice Settings

      • Private Practice
      • Home Health
      • Outpatient Rehab
      • Inpatient Rehab
      • CORFs
      • Skilled Nursing Facilities
      • Hospitals

    Advanced Beneficiary Notice of Noncoverage (ABN)

      • ABN Form and Instructions
      • ABN Preparation Requirements
      • ABN Notice and Delivery
      • Triggering Events
      • When it is Mandatory to Issue an ABN?
      • When it is Voluntary to Issue an ABN?
      • Issuing the ABN
      • Routine Notice Prohibitions and Exceptions
      • ABN Modifiers

    About Us

    Therapy Comply is a healthcare compliance firm that seeks to bring high quality web-based compliance guidance and one-on-one consulting services to small and medium size physical, occupational, and speech therapy practices.

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