Posts tagged ‘42 CFR 409.44(C)(2)(i)(C)’

September 19, 2011

Read up on PT assessment exceptions

CMS has answered issues with single therapy visits …

Question: Can you please clarify this for me? If we are only doing physical therapy (PT) and the 30-day re-evaluation not only falls on the 12 visit and on a Friday and then come Monday is the 13 visit, do I have to send out the PT for another re-evaluation? We are concerned that a 30-day reassessment conducted on the 12th PT visit in single therapy cases will not suffice to meet the 13th therapy visit assessment. If it doesn’t meet requirements, there would be a large financial impact based on non-coverage of subsequent PT visits.

CMS Response: You are correct that for a single therapy case, the therapist must do the reassessment visit exactly on the 13th and 19th visits, unless the rural or documented circumstances outside the control of the therapist exceptions apply as stated in 42 CFR 409.44(C)(2)(i)(C). If neither exception applies, the PT would need to do the reassessment on the 13th visit as required by the regulations.