Who can establish a therapy plan of care (POC)?

Outpatient therapy services shall be furnished under a plan established by:

• A physician/NPP (consultation with the treating physical therapist, occupational therapist, or speech-language pathologist is recommended. Only a physician may establish a plan of care in a CORF;
• The physical therapist who will provide the physical therapy services;
• The occupational therapist who will provide the occupational therapy services; or
• The speech-language pathologist who will provide the speech-language pathology services.

Who must sign the POC?

The person who established the plan must sign and date the plan.  The physician/NPP must also certify the plan by signing and dating it.

See Certification for more information.

Can treatment begin before a POC has been established?

Treatment may begin before the plan is committed to writing only if the treatment is performed or supervised by the same clinician who establishes the plan. Payment for services provided before a plan is established may be denied.

What must be included in the POC?

The plan of care shall contain, at minimum:

• Diagnoses;
• Long term treatment goals; and
• Type, amount, duration and frequency of therapy services.

References

Medicare Benefit Policy Manual Ch. 15 – Covered Medical and Other Health Services §220.1.2

Billing and Coding: Outpatient Physical and Occupational Therapy Services: A57067