Recently, the Centers for Medicare & Medicaid Services (CMS) clarified that an expectation for functional or clinical improvement was not a requirement to receive payment for physical therapy services. This includes many life-threatening, chronic, or degenerative conditions. This clarification requires a different approach to clinical documentation and clinical decision-making. The onus rests on the physical therapist and the physical therapist assistant to clearly document medical necessity and that interventions required the skill of a physical therapist. Many other private insurance providers still require an expectation of clinical improvement to justify payment for physical therapy.
1Board Certified Geriatric Clinical Specialist; Assistant Professor, Oakland University, Rochester, MI; Education Coordinator, Beaumont Hospital, Troy, MI; and Chairperson, Hospice/Palliative Care Special Interest Group of the Oncology Section of APTA
2Physical Therapist, Ascension St. John Hospital, Warren, MI; and Doctor of Science in Physical Therapy Candidate, Oakland University, Rochester, MI
Correspondence: Christopher M. Wilson, PT, DPT, DScPT, Physical Therapy Program, School of Health Sciences, Oakland University, 433 Meadowbrook Rd, Rochester, MI 48309 (Wilson23@oakland.edu).
The authors declare no conflicts of interest.