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Benchmark physical therapy old national professional#

Home-based physical therapy is considered medically necessary in selected cases based upon the member's needs (i.e., the member must be homebound).

Once therapeutic benefit has been achieved, or a home exercise program could be used for further gains, continuing supervised physical therapy is not considered medically necessary.

Physical therapy in persons whose condition is neither regressing nor improving is considered not medically necessary.

Physical therapy in asymptomatic persons or in persons without an identifiable clinical condition is considered not medically necessary.

The PT plan of care should be of such sufficient detail and include appropriate objective and subjective data to demonstrate the medical necessity of the proposed treatment (see Appendix for documentation requirements)

PT must be provided in accordance with an ongoing, written plan of care that is reviewed with and approved by the treating physician in accordance with applicable state laws and regulations.

As physicians are not licensed as physical therapists, they may not directly supervise physical therapy assistants and Services may be provided personally by physicians and performed by personnel under their direct supervision as permitted under state laws.

Benchmark physical therapy old national professional#

The services provided must be of the complexity and nature to require that they are performed by a licensed professional therapist or provided under their direct supervision by a licensed ancillary person as permitted under state laws.All services provided must be within the applicable scope of practice for the provider in their licensed jurisdiction where the services are provided and

PT services must be ordered by a physician or other licensed health care practitioner and performed by a duly licensed and certified, if applicable, PT provider.The PT services provided are intended to cover only episodes of therapy for situations where there must be a reasonable expectation that a member’s condition will improve significantly in a reasonable and generally predictable period of time and.These services must be proposed for the treatment of a specific illness or injury and The member’s participating physician or licensed health care practitioner has determined that the member’s condition can improve significantly based on physical measures (eg, active range of motion (AROM), strength, function or subjective report of pain level) within one month of the date that therapy begins or the therapy services proposed must be necessary for the establishment of a safe and effective maintenance program that will be performed by the member without ongoing skilled therapy services.This Clinical Policy Bulletin addresses physical therapy.Īetna considers physical therapy (PT) medically necessary when this care is prescribed by a chiropractor, DO, MD, nurse practitioner, podiatrist or other health professional qualified to prescribe physical therapy according to State law in order to significantly improve, develop or restore physical functions lost or impaired as a result of a disease, injury or surgical procedure, and the following criteria are met: Number: 0325 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References