Physical therapy in the home is considered for payment if it meets the following criteria:
a. Prior to hospitalization, the patient had total functional capacity for self-care, ambulation and movement.
b. It fills the functional needs of the patient who was discharged from the hospital, after suffering from an illness, surgery or injury, which limits the person in their functions or daily living activities.
Example: The patient’s walking mode does not offer safety. This must be documented in a way that evidences the need for a physical therapy program in the home.
c. To reach the goal of improvement in a predictable and reasonable period of time.
d. Provide a specific, reasonable and effective treatment for the diagnosis and condition of the patient.
• Example: The goal of physical therapy is to progress the patient from a state of confinement or dependence from one team to another or none, to ambulate safely, etc.
They are offered under the supervision of a participating doctor.
F. They require the judgment, knowledge and skills of qualified personnel.
It covers session (which can be one hour) and all the necessary modalities. A session should include:
The exercise program (coordination and restriction) to increase strength and
The education of the family on the exercise program to offer continuity.
The care plan should include:
The duration time with your long and short term goals.
Modalities and exercises that will be used in the treatment.
The frequency and duration of treatment.
These services must be authorized by the Individual Case Management Section.
It is not considered for payment:
1. Duplicate therapy (physical and occupational should provide different treatments).
2. Treatment that does not require a qualified provider with special skills such as:
a. Passive movement (range of motion) arc not related to the restoration of the loss of a specific function.
b. None of the following when given separately or to a patient who has no complications (paraffin baths, hot or cold packs, whirlpool heat by infrared rays, etc.).
3. Maintenance programs.
