Medicare Requirements for Home Health Physical Therapy Visits

Medicare is a government health care program for the elderly and disabled, two groups that are often prone to issues that affect mobility to the point that physical therapy may be required. Visits to the doctor's office or hospital may be stressful and taxing on the body. Fortunately, Medicare offers a home health benefit for those who need physical therapy, have a hard time leaving home and meet other requirements.

Homebound

• In order to qualify for any home health care, you must be considered homebound, meaning that it is difficult for you to leave your home without considerable effort. You may need the help of a walker or a wheelchair to get around. This does not mean, however, that you can never leave your home. Individuals who are considered homebound may leave home to receive medical care or attend religious ceremonies and special events. A doctor must certify you as homebound.

Medical Necessity

• The physical therapy you require must be considered medically necessary and must be ordered by a qualified physician.

Plan of Care

• A doctor and a home health agency representative must design a plan of care together. The plan of care is good for 60 days. If you still need care after 60 days, the plan of care must be revisited and re-approved. Medicare will continue to cover physical therapy at home as long as there is a renewed plan of care.

Medicare-Approved Home Health Agency

• Original Medicare will only cover home health care from a home health agency that is certified by Medicare. This means that beneficiaries may have to shop around before they find a home health agency that will accept them and is Medicare-certified.

Network

• If you have a Medicare private plan, your plan may have a network of providers. If so, you will need to find a home health agency that is in your plan's network in order for the private plan to cover your care.

Home Health Advance Beneficiary Notice

• If the home health agency does not believe that Medicare will pay for the home health service, then the agency must provide you with a “Home Health Advance Beneficiary Notice.” Once you are given notice, you can decide to seek services elsewhere or take the risk of receiving services at the first home health agency instead. If the agency does not provide this notice, you are not responsible for the cost of care if Medicare denies payment.