AAPM&R Post-Acute Care (PAC) Toolkit

Quality & Practice


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Payment: Physician

Physician services are defined by the Medicare Physician Fee Schedule (PFS). Medicare payments are mandated by the PFS, which sets relative value units (RVUs) for each service the physician provides. The services are defined by the Healthcare Common Procedure Coding System (HCPCS). These RVUs are meant to account for the relative costliness associated with the services provided, including; clinician work, practice expenses, and professional liability insurance costs.[i] 

Outpatient Therapy Services

Outpatient therapy services consist of physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP). Medicare covers these services if a physician, therapist, or non-physician practitioner documents the need in a written treatment plan. This plan must be re-certified every 90 days. All services are classified by the HCPCS.

[i] Medicare Payment Advisory Commission. Payment Basics: Outpatient Therapy Services Payment System. http://medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_17_opt_final06a411adfa9c665e80adff00009edf9c.pdf?sfvrsn=0. October 2017. Accessed May 29, 2019.