In-Home Physical Therapy

Author: Paul Singh

Physical therapy can be provided in a variety of settings, such as in a hospital or in an outpatient PT clinic. If a patient has difficulty leaving their home to go to therapy or it presents a health risk, in-home physical therapy may be beneficial. The patient has the convenience of receiving the treatment in their own home rather than deal with weather conditions, heavy traffic and getting in and out of the vehicle. The patient also receives one-on-one care with a therapist’s undivided attention and getting therapy in a familiar setting is often less stressful for the patient.

Depending on the circumstances, in-home physical therapy is covered by Medicare under a predetermined base payment. In the case of in-home physical therapy, it is the Patient-Driven Groupings Model (PDGM). In-home physical therapy services are also subject to quality reporting requirements using the Outcome and Assessment Information Set (OASIS).

In-home physical therapy is covered at 100% under the patient’s Medicare Part A benefit as long as the patient meets the following criteria:

  1. The patient is homebound and it is extremely difficult for them to leave their home and they need help doing so.
  2. The patient needs skilled therapy care on an intermittent basis. Intermittent means the patient needs care at least once every 60 days and at most once a day for up to three weeks.
  3. The patient has a face-to-face meeting with a doctor within the 90 days before a patient starts in-home physical therapy, or the 30 days after the first day they receive care. This can be an office visit, hospital visit, or in certain circumstances, video conferencing.
  4. The patient’s doctor signs a home health certification confirming the patient is homebound and needs intermittent skilled care. The certification must state that the patient’s doctor has an approved plan of care (POC) and that the face-to-face requirement was met.
    • Note: The patient’s doctor should review and certify the patient’s home health plan every 60 days. A face-to-face meeting is not necessary for recertification.
  5. And lastly, the patient receives care from a Medicare-certified home health agency (HHA).

There are no caps or limits to in-home physical therapy services covered under Medicare Part A. Patients receiving in-home physical therapy receive an individualized POC and treatment is provided on a one-on-one basis. In-home therapy also allows the physical therapist to perform a Home Safety Evaluation and provide the patient with a checklist of needed modifications and recommendations.

Another thing to remember is that a patient cannot qualify for Medicare in-home health coverage if the patient only needs occupational therapy.

However, if the patient qualifies for in-home physical therapy, then the patient can receive occupational therapy as well. When the patient no longer qualifies for home health services under Medicare Part-A, they are able to continue receiving therapy services under Outpatient Medicare Part-B. These services can also be provided in the home if they meet the need.

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