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24.5.8 Physical Therapy (PT) Services
As stated in the TAC, in order to be payable as a Home Health Services benefit, PT services must be:
• Requested for a payable ICD-9-CM diagnosis code.
•Provided by a physical therapist or physical therapist assistant. A physical therapist assistant must be supervised by a licensed physical therapist who is currently licensed by the Executive Council of Physical Therapy and Occupational Therapy Examiners.
•For the treatment of an acute musculoskeletal or neuromuscular condition or an acute exacerbation of a chronic musculoskeletal or neuromuscular condition.
•Expected to improve the client's condition in a reasonable and generally predictable period of time, based on the physician's assessment of the client's restorative potential after any needed consultation with the therapist.
•The evaluation and function-oriented treatment of individuals whose ability to function in life roles is impaired by recent or current physical illness, injury, or condition.
•Specific goal-directed activities to achieve a functional level of mobility and communication and prevent further dysfunction within a reasonable length of time based on the therapist's evaluation and physician's assessment and POC.
•PT POC should encourage the client and other caregivers to learn self-therapy skills to the greatest extent possible while still providing all medically necessary services.
•Provided only until the client has reached the maximum level of improvement. Repetitive services designed to maintain function when the maximum level of improvement has been reached are not a benefit. Services related to activities for the general good and welfare of clients, such as general exercises to promote overall fitness and flexibility, and activities to provide diversion or general motivation are not reimbursed.
•Billed by the home health agency and reimbursed to the home health agency.
Independently-enrolled therapists are not reimbursed under Home Health Services.
PT authorization must be requested by the home health agency's RN and recommended to be done after the RN home assessment. Requests are not accepted, nor authorization granted, directly to the PT or assistant PT.
Note: THSteps-eligible clients who qualify for medically necessary services beyond the limits of this Home Health Services benefit will receive those services through THSteps-CCP. Refer to: Section 24.3.1, "Eligibility."
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