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Physical Therapists - High Use of Outpatient Physical Therapy Services

Previous OIG work found that claims for therapy services provided by independent physical therapists were not reasonable, were not properly documented, or the therapy services were not medically necessary. Medicare will not pay for items or services that are not "reasonable and necessary" (SSA § 1862(a)(1)(A)). We will review outpatient physical therapy services provided by independent therapists to determine whether they were in compliance with Medicare reimbursement regulations. Our focus is on independent therapists who have a high utilization rate for outpatient physical therapy services. Documentation requirements for therapy services can be found in Centers for Medicare & Medicaid Services's Medicare Benefit Policy Manual, Pub. No. 100-02, Ch. 15, § 220.3.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
October 2017 Centers for Medicare & Medicaid Services Physical Therapists - High Use of Outpatient Physical Therapy Services Office of Audit Services W-00-16-35220; various reviews 2018

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201