CMS Pub. 100-02, ch. 8, § 30.4

A3-3132.1.C, SNF-214.1.C

The following sections contain examples and guidelines concerning direct skilled therapy

services to patients, including skilled physical therapy, occupational therapy, and

speech/language pathology therapy.

Coverage for such skilled therapy services does not turn on the presence or absence of a

beneficiary’s potential for improvement from therapy services, but rather on the

beneficiary’s need for skilled care. Therapy services are considered skilled when they are

so inherently complex that they can be safely and effectively performed only by, or under

the supervision of, a qualified therapist. (See 42CFR §409.32) These skilled services

may be necessary to improve the patient’s current condition, to maintain the patient’s

current condition, or to prevent or slow further deterioration of the patient’s condition.

If all other requirements for coverage under the SNF benefit are met, such skilled therapy

services are covered when an individualized assessment of the patient’s clinical condition

demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist

are necessary for the performance of the rehabilitation services.