ARCHIVED

Medical Policy

Policy Num:       08.001.001
Policy Name:    Physical Therapy in the home
Policy ID:          [08.001.001][Ac L M + P+ ][0.00.00]

Last Review:      November 11, 2020
Next Review:      ARCHIVED
Issue:                   11:2020        

Related Policies: 

None

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Physical Therapy in the home

Summary

Physical therapy is the treatment of an illness or injury with the use of therapeutic exercises or interventions that are focused on improving posture, locomotion, strength, support, balance, coordination, or movement of articulation.

Objective

The objective of this review is to assure physical therapy at home have the same outcomes as the one at the facility.

Policy Statements

Physical therapy in the home is considered for payment if it meets the following criteria:

a. Prior to hospitalization, the patient had total functional capacity for self-care, ambulation and movement.

b. It fills the functional needs of the patient who was discharged from the hospital, after suffering from an illness, surgery or injury, which limits the person in their functions or daily living activities.

Example: The patient's walking mode does not offer safety. This must be documented in a way that evidences the need for a physical therapy program in the home.

c. To reach the goal of improvement in a predictable and reasonable period of time.

d. Provide a specific, reasonable and effective treatment for the diagnosis and condition of the patient.

• Example: The goal of physical therapy is to progress the patient from a state of confinement or dependence from one team to another or none, to ambulate safely, etc.

They are offered under the supervision of a participating doctor.

F. They require the judgment, knowledge and skills of qualified personnel.

It covers session (which can be one hour) and all the necessary modalities. A session should include:

The exercise program (coordination and restriction) to increase strength and

The education of the family on the exercise program to offer continuity.

The care plan should include:

The duration time with your long and short term goals.

Modalities and exercises that will be used in the treatment.

The frequency and duration of treatment.

These services must be authorized by the Individual Case Management Section.

It is not considered for payment:

1. Duplicate therapy (physical and occupational should provide different treatments).

2. Treatment that does not require a qualified provider with special skills such as:

a. Passive movement (range of motion) arc not related to the restoration of the loss of a specific function.

b. None of the following when given separately or to a patient who has no complications (paraffin baths, hot or cold packs, whirlpool heat by infrared rays, etc.).

3. Maintenance programs.

Policy Guidelines

The measure of success of a rehabilitation program should not focus on length of survival but rather on quality of life, function/independence, and psychosocial well-being.  Objective outcome measures of rehabilitation in patient care may involve patient-reported parameters, such as improvement in mobility, pain scores, anxiety levels, and satisfaction with care, as well as caregiver-related outcomes, such as caregiver burden and QOL.

Benefit Application

BlueCard/National Account Issues

N/A

Background

Home-based rehabilitation may be appropriate for patients whose rehabilitation needs are not extensive, or whose performance or functional status precludes them from more intensive rehabilitation programs. Home-based rehabilitation is usually offered through home care and home hospice programs, and most can provide physical therapy, occupational therapy, speech therapy, social work, and skilled nursing care on an intermittent basis to home-confined patients who are not necessarily bedridden. Rehabilitation therapies are not offered on a daily basis, and the services provided are contingent upon the skilled need of the patient and the goals to be attained. A physician must certify a skilled nursing or rehabilitation need for eligible patients to help them recover from illness, injury, or an acute condition. Medicare Part A, Medicaid, and most private insurances cover this level of service.

Regulatory Status

N/A

Rationale

Population Reference No. 1 Policy Statement

Individuals with physical injuries treated with physical therapy in the home setting

Supplemental Information

N/A

Practice Guidelines and Position Statements

N/A

Medicare National Coverage

N/A

References

1.  Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81:

2.  Little P, Lewith G, Webley F, et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ 2008; 337:a884

3.  Glass LS, Harris JS, Blais BR, et al. Occupational Medicine Practice Guidelines: Evaluation and Management of Common    Health Problems and Functional Recovery of Workers, 2nd ed, OEM Press, Beverly Farms, MA 2003.

      4. Weiner DK, Haggerty CL, Kritchevsky SB, et al. How does low back pain impact physical function in independent, well-   functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med 2003; 4:311

Codes

Appplicable Modifiers

Some modifiers

Policy History