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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 10111 Contractor Type: MAC A

LCD Information

LCD ID Number: L34428 Status: A-Approved LCD Title: Outpatient Physical Therapy Geographic Jurisdiction: Alabama Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 05/18/2023 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations 42 CFR §409.32 Criteria for skilled services and the need for skilled services 42 CFR §410.32(b)(3) Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions 42 CFR §410.61 Plan of treatment requirements for outpatient rehabilitation services 42 CFR §424.24 Requirements for medical and other health services furnished by providers under Medicare Part B CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.5.2 Coverage of Outpatient Therapeutic Services Incident to a Physician’s Service Furnished on January 1, 2010 through December 31, 2019 CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 8, §30.2.2.1 Documentation to Support Skilled Care Determinations, §30.4.1.1 General, §30.4.1.2 Application of Guidelines and §30.6 Daily Skilled Services Defined CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 12, §10 Comprehensive Outpatient Rehabilitation Facility (CORF) Services Provided By Medicare, §20.1 Required Services, §20.2 Optional CORF Services, §40.1 Physician’s Services, §40.2 Physical Therapy Services and §40.7 Social and/or Psychological Services CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §220 Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance, §220.1.1 Care of a Physician/Nonphysician Practitioner (NPP), §220.1.2 Plans of Care for Outpatient Physical Therapy, Occupational Therapy, or Speech-Language Pathology Services, §220.1.3 Certification and Recertification of Need for Treatment and Therapy Plans of Care, §220.1.4 Requirement That Services Be Furnished on an Outpatient Basis, §220.2 Reasonable and Necessary Outpatient Rehabilitation Therapy Services, §220.3 Documentation Requirements for Therapy Services, §230 Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology, §230.1 Practice of Physical Therapy, §230.4 Services Furnished by a Therapist in Private Practice (TPP), §230.5 Physical Therapy, Occupational Therapy and Speech-Language Pathology Services Provided Incident to the Services of Physicians and Non-Physician Practitioners (NPP) CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 1, §10.2 Transcutaneous Electrical Nerve Stimulation (TENS) for Acute Post-Operative Pain, §30.1 Biofeedback Therapy, §30.1.1 Biofeedback Therapy for the Treatment of Urinary Incontinence CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §150.5 Diathermy Treatment, §150.8 Fluidized Therapy Dry Heat for Certain Musculoskeletal Disorders, §160.2 Treatment of Motor Function Disorders with Electric Nerve Stimulation, §160.7 Electrical Nerve Stimulators, §160.12 Neuromuscular Electrical Stimulator (NMES), §160.15 Electrotherapy for Treatment of Facial Nerve Palsy (Bell’s Palsy), §160.27 Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 3, §170.1 Institutional and Home Care Patient Education Programs CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, §240.3 Heat Treatment, Including the Use of Diathermy and Ultra-Sound for Pulmonary Conditions, §240.8 Pulmonary Rehabilitation Services, §270.1 Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds, §270.4 Treatment of Decubitus Ulcers, §270.6 Infrared Therapy Devices Sorry, you need to login or register to view additional sections of this Medicare policy. *