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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 Therapy Coverage

The basic criteria for coverage of physical, occupational, and speech therapy under Medicare and guidelines for medical necessity.  Members can email us questions regarding any Medicare billing, coverage, or compliance issue, so please consider joining today if you need assistance. 


Medical Necessity 

    • Medical Necessity FAQs
    • Expertise
    • Complexity and Sophistication
    • Needs of the Patient
    • When Services are not Considered Medically Necessary
    • Documenting Skilled Therapy

Maintenance Programs

    • How does Medicare define maintenance programs?
    • What conditions are required in order for a maintenance program to be covered?
    • When is a maintenance program not covered?
    • What needs to be documented when a maintenance program needs to be revised?
    • Examples of maintenance programs

Occupational Therapy Guidelines

    • What is included in the practice of occupational therapy?
    • Patients with psychiatric illness
    • Vocational and prevocational assessment and training

Conditions for Coverage

    • Services are medically necessary
    • Services are furnished under a plan of care
    • Services are furnished under the care of a physician
    • The plan of care is certified by a physician/NPP

Rehabilitative Therapy

    • What should be included in a POC for rehabilitative therapy?
    • Is rehabilitative therapy appropriate if the patient has a chronic or terminal condition?
    • What should be included in the documentation?
    • When is rehabilitative therapy considered to be successful?
    • When is rehabilitative therapy not medically necessary?

Speech-Language Pathology Guidelines

    • Evaluation Services
    • Therapeutic Services
    • Auditory Impairments
    • Dysphagia

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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Join today as either a monthly or a yearly member and enjoy full access to the site and a significant discount to our live and recorded webinars.  Members also have access to compliance and billing support.

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