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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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Outpatient Rehabilitation Definitions

Clinic - A facility that is established primarily to furnish outpatient physician services and that meets the following tests of physician involvement:

    • The medical services are furnished by a group of three or more physicians practicing medicine together.
    • A physician is present during all hours of operation of the clinic to furnish medical services, as distinguished from purely administrative services.

Extension Location- A location or site from which a rehabilitation agency provides services within a portion of the total geographic area served by the primary site. The extension location is part of the rehabilitation agency. The extension location should be located sufficiently close to share administration, supervision, and services in a manner that renders it unnecessary for the extension location to independently meet the conditions of participation as a rehabilitation agency.

Organization - A clinic, rehabilitation agency, or public health agency.

Public Health Agency - An official agency established by a State or local government, the primary function of which is to maintain the health of the population served by performing environmental health services, preventive medical services, and in certain cases, therapeutic services.

Rehabilitation Agency - An agency that:

    • Provides an integrated interdisciplinary rehabilitation program designed to upgrade the physical functioning of handicapped disabled individuals by bringing specialized rehabilitation staff together to perform as a team; and
    • Provides at least physical therapy or speech-language pathology services.

Supervision - Authoritative procedural guidance that is for the accomplishment of a function or activity and that:

    • Includes initial direction and periodic observation of the actual performance of the function or activity; and
    • Is furnished by a qualified person:
      • Whose sphere of competence encompasses the particular function or activity; and
      • Who (unless otherwise provided in this subpart) is on the premises if the person performing the function or activity does not meet the assistant-level practitioner qualifications.

Reference

42 C.F.R. §485.703

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