CMS Pub. 100-02, ch. 15, § 220.1.4

Basis

(Rev. 179, Issued: 01-14-14, Effective: 01-07-14, Implementation: 01-07-14)

Reference: 42CFR410.60

Therapy services are payable under the Physician Fee Schedule when furnished by 1.) a

provider to its outpatients in the patient’s home; 2.) a provider to patients who come to

the facility’s outpatient department; 3.) a provider to inpatients of other institutions, or

4.) a supplier to patients in the office or in the patient’s home. (CORF rules differ on

providing therapy at home.)

Coverage includes therapy services furnished by participating hospitals and SNFs to their

inpatients who have exhausted Part A inpatient benefits or who are otherwise not eligible

for Part A benefits. Providers of therapy services that have inpatient facilities, other than

participating hospitals and SNFs, may not furnish covered therapy services to their own

inpatients. However, since the inpatients of one institution may be considered the

outpatients of another institution, all providers of therapy services may furnish such

services to inpatients of another health facility.

A certified distinct part of an institution is considered to be a separate institution from a

nonparticipating part of the institution. Consequently, the certified distinct part may

render covered therapy services to the inpatients of the noncertified part of the institution

or to outpatients. The certified part must bill the A/B MAC (A) under Part B.

Therapy services are payable when furnished in the home at the same physician fee

schedule payment rates as in other outpatient settings. Additional expenses incurred by

providers of outpatient therapy due to travel to the beneficiary are not covered.

Under the Medicare law, there is no authority to require a provider to furnish a type of

service. Therefore, a hospital or SNF may furnish therapy to its inpatients without having

to set up facilities and procedures for furnishing those services to its outpatients.

However, if the provider chooses to furnish a particular service, it may not charge any

individual or other person for items or services for which the individual is entitled to have

payment made under the program because it is bound by its agreement with Medicare.

Thus, whenever a hospital or SNF furnishes outpatient therapy to a Medicare beneficiary

(either directly or under arrangements with others) it must bill the program under Part B

and may charge the patient only for the applicable deductible and coinsurance.