decisionhealth Newsletters, Answer Books - 2006 Issue 7 (July)
Medicare_Benefit_Policy_Manual / Chapter_15 / 230.1
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Article Overview
This article explains Medicare policy for physical and occupational therapists practicing in private practice. It covers who may furnish services, how private practice is defined, where services may be delivered, enrollment and supervision considerations, and how payment and therapy expense limitations are addressed. The content is relevant to therapists, physician groups, billing staff, and compliance teams working with Medicare outpatient therapy rules.
Why This Topic Matters
Understanding this policy helps practices distinguish private practice therapy from other furnishing arrangements and align Medicare billing, enrollment, and supervision processes with the applicable benefit rules.
Article Sections
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Services Furnished by a Physical or Occupational Therapist in Private Practice
Overview of Medicare’s private practice framework for therapy services, including eligible practice arrangements and the relationship between therapists, physician groups, and beneficiaries.
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Practice Locations and Office Requirements
Discussion of where services may be furnished and how the practice office is defined for private practice purposes, including location and use considerations.
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Enrollment, Supervision, and Supplier Rules
Explanation of approval, assignment, and supervision topics for therapy suppliers, including distinctions between private practice rules and incident-to arrangements.
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Payment and Therapy Expense Limitations
Summary of the Medicare payment basis for these services and the related discussion of therapy expense limitations and benefit scope.
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Notes on Noncovered Arrangements
Additional policy notes describing situations and service arrangements that are outside the scope of this provision.
What You Will Learn
- How Medicare defines private practice therapy arrangements
- What types of provider relationships are addressed in the policy
- Where private practice therapy services may be furnished
- How supervision and supplier status are treated in this context
- How Medicare payment and therapy expense limitations are described
- Which service arrangements are excluded from this provision
Who Should Read This
- Physical therapists
- Occupational therapists
- Therapy practice owners
- Physician group administrators
- Medical billing and coding staff
- Compliance professionals
Codes Discussed
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