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Medicare Therapeutic Procedures

18 Mar 2021 10:33 AM | Zachary Edgar (Administrator)
Medicare therapeutic procedures has been updated.

Sample: 

Service: Therapeutic Exercise

Code: 97110

Description

Therapeutic exercises are used for the purpose of restoring or maintaining strength, endurance, range of motion and flexibility where loss or restriction is a result of a specific disease or injury and has resulted in a functional limitation. Therapeutic exercises may require active, active-assisted, or passive participation by the patient (e.g., isokinetic exercise, lumbar stabilization, stretching and strengthening).

Indications – Medical Necessity

Therapeutic exercise is considered reasonable and necessary if at least one of the following conditions is present and documented:

  • The patient having weakness, contracture, stiffness secondary to spasm, spasticity, decreased joint ROM, functional mobility deficits, balance and/or coordination deficits, abnormal posture, muscle imbalance; and
  • The patient needing to improve mobility, flexibility, strengthening, coordination, control of extremities, dexterity, ROM, or endurance as part of ADL training, or reeducation.

Limitations

Exercises to promote overall fitness, flexibility, endurance (in absence of a complicated patient condition), aerobic conditioning, weight reduction, and maintenance exercises to maintain range of motion and/or strength are non-covered. In addition, exercises that do not require, or no longer require, the skilled assessment and intervention of a qualified professional/auxiliary personnel are non-covered. Repetitive type exercises often can be taught to the patient or a caregiver as part of a self-management, caregiver or nursing program.

Documentation

Documentation for therapeutic exercise typically includes objective loss of joint motion, strength, and /or mobility (e.g., degrees of motion, strength grades, levels of assistance).

Documentation should include not only measurable indicators such as functional loss of joint motion or muscle strength, but also information on the impact of these limitations on the patient’s life and how improvement or maintenance in one or more of these measures effects patient function.

Documentation of progress should show the condition is responsive to the therapy chosen and that the response is (or is expected to be) clinically meaningful. Metrics of progress that are functionally meaningful (or obviously related to clinical functional improvement) should be documented wherever possible. For example, long courses of therapy resulting in small changes in range of motion might not represent meaningful clinical progress benefiting the patient’s function.

Documentation must clearly support the need for continued therapeutic exercise greater than 12-18 visits.

Supportive documentation for therapeutic exercises:

  • Objective measurements of loss of strength and range of motion (with comparison to the uninvolved side) and effect on function;
  • If used for pain include pain rating, location of pain, effect of pain on function Specific exercises performed, purpose of exercises as related to function, instructions given, and/or assistance needed to perform exercises to demonstrate that the skills of a therapist were required; and
  • When skilled cardiopulmonary monitoring is required, include documentation of pulse oximetry, heart rate, blood pressure, perceived exertion, etc.

NCCI - PTP

N/A

NCCI – MUE

 Service  Max Units  Adjudication 
 Therapeutic Exercise  6  3

Reference

L34427 – Outpatient Occupational Therapy – Palmetto GBA

L34049 – Outpatient Physical and Occupational Therapy Services – CGS Administrators

L33413 – Therapy and Rehabilitation Services – First Coast Service Options

L35036 – Therapy and Rehabilitation Services – Novitas Solutions

 

About Us

Zachary Edgar JD, LLM is the managing partner for Therapy Comply.  Zachary is a healthcare attorney that specializes in federal and state healthcare regulatory issues particularly for physical, occupational, and speech therapy practices.  

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