As of Monday, July 25, Medicare will only pay for physical therapy services provided in physician offices “incident to” the physician’s services if the physical therapy services are provided by “qualified personnel” as defined in a June 24 transmittal to Medicare contractors.

The immediate implementation of the standards follows the dismissal last week in a Texas federal court of a lawsuit filed by the National Athletic Trainers Association (NATA) challenging the personnel standards, as explained in a new MedLearn article (click here for the article) released by the Centers for Medicare and Medicaid Services.

In addition to the implementation of the personnel requirements for physical therapy services provided incident to a physician/NPP, Section 230.5 of the Medicare Benefit Policy Manual also clarifies the requirement that services provided by PTAs cannot be billed incident to the physician/NPP’s services. PTAs must be supervised by a physical therapist in all treatment settings, including in a physician/NPP office. The services of PTAs are covered under the benefit for physical therapy services and not under the benefit for services provided incident to a physician/NPP. In order to bill for the PTA’s services in a setting where the PT and PTA are employed by a physician/NPP, the PT would need his or her own Medicare provider number. Payment for physical therapy services billed using the PT provider number would then be reassigned to the physician/NPP.

Physicians may bill for therapy services as incident to services only if the ancillary personnel meet the qualifications of 42 CFR 484.4, which require that the individual must at least be a graduate of a training program. These individuals need not be licensed unless required by state law. Pennsylvania requires licensing for physical therapists, occupational therapists and speech and hearing therapists.

Contact Kent Culley if you have any questions.