1. General

To be covered as physical therapy all of the following conditions must be met;

a. The services are directly and specifically related to an active written treatment regimen designed by the physician after any needed consultation with the qualified physical therapist;

b. The services are of such a level of complexity and sophistication or the condition of the patient is such that the judgment, knowledge and skills of a qualified physical therapist are required;

c. The services are, in fact, performed by or under the supervision of a qualified physical therapist, i.e., the qualified physical therapist provides authoritative procedural guidance for the rendering of the services with initial direction and periodic inspection of the actual act and is on the premises if the person performing the services does not meet the assistant-level qualifications;

d. The services are provided with the expectation, based on the assessment made by the physician of the patient's restoration potential after any needed consultation with the qualified physical therapist, that the patient will improve significantly in a reasonable and generally predictable, period of time (see 2. below) or must be necessary to the establishment of a safe and effective maintenance program required in connection with a specific disease state (see 3. below);

e. The services are considered under accepted standards of medical practice to be a specific and effective treatment for the patient's condition; and

f. The services are reasonable and necessary to the treatment of the patient's condition.

Many inpatients who do not require physical therapy services as defined above do require services involving procedures which are routine in nature in the sense that they can be rendered by supportive personnel, e.g., aides or nursing personnel, without the supervision of a qualified physical therapist. Such services as well as services involving activities for the general good and welfare of patients, e.g., general exercises to promote overall fitness and flexibility and activities to provide diversion or general motivation, do not constitute physical therapy services for Medicare purposes. However, since they constitute an essential and integral part of good inpatient care, such services can be billed through the physical therapy cost center even though they do not constitute physical therapy for Medicare purposes, if the following conditions are met: the services are medically necessary; the treatment furnished is prescribed by a physician; all services are provided by salaried employees of the physical therapy department of the provider; the cost incurred is reasonable in amount; and charges are equally imposed on all patients.