CMS Implements Policy Restricting the Provision of Medicare Incident-to Therapy Services

The United States District Court for the Northern District of Texas has dismissed the National Athletic Trainer’s Association (NATA) lawsuit against CMS that challenged the new Medicare requirements for non-physicians providing physical and occupational therapy incident to a physician. The court stated that it did not have subject matter jurisdiction to consider the case. NATA has announced that it intends to ask the court to re-consider its dismissal of the case.

Following the court’s dismissal of the lawsuit, as of July 25, 2005, CMS has implemented the rule limiting who may provide incident-to therapy services under Medicare and the rule became effective immediately. The rule requires that physical therapists must supervise physical therapist assistants (PTAs) providing services to Medicare beneficiaries. The level and frequency of supervision required varies based on state law. Physicians cannot supervise a PTA and cannot bill a PTA’s services as incident-to the physician’s service. The services provided by a PTA will be covered under Medicare’s therapy benefit and should be billed under the supervising physical therapist’s provider number. Therefore, it is important that physicians ensure that physical therapists enroll in Medicare and obtain a provider number. The therapist may then assign their collections to the physician or the practice.

Additionally, the rule states that PT aides, athletic trainers, kinesiotherapists, recreation therapists, massage therapists, and chiropractors cannot bill for therapy services under Medicare. However, nurse practitioners, clinical nurse specialists, and physician assistants may continue to provide therapy services incident-to a physician and bill the services under the physician’s provider number.

For additional information, contact the AAPM&R national office at (312)464-9700 or via e-mail: info@aapmr.org.