Revised Medicare Policy on Certification and Re-Certification of Therapy Plans

Medicare’s revised policy on coverage of outpatient rehabilitation therapy services published June 24, 2005, in the Medicare Benefit Policy Manual includes a change in policy on re-certification of therapy plans. As in the past, Medicare requires an initial certification for a therapy plan of care by a physician or non-physician practitioner (NPP). While the patient needs to be under the care of a physician or NPP, it does not need to be the physician or NPP who certifies the plan of care. Acceptable documentation of certification includes, but is not limited to, a physician’s progress note, a physician or NPP order, or a care plan signed and dated by a physician or NPP. The initial certification is in effect for 30 calendar days or one month of treatment.

When therapy services extend beyond the initial one month of treatment, the care plan must be reviewed, dated, and signed by a physician or NPP every 30 days to comply with Medicare’s payment and coverage policies. Effective June 6, 2005, with the policy’s implementation, Medicare no longer requires a physician visit for re-certification unless the National Coverage Determination (NCD) for a specific treatment requires a visit.  This is a change from the previous policy, which required a physician visit for re-certification. The physician or NPP who re-certifies the plan does not need to be the same person who ordered or originally certified the plan. Additionally, the physician or NPP may certify or re-certify a plan of care for less than 30 days, if deemed appropriate for the patient’s treatment.