CMS Pub. 100-03, ch. 1, § 170.1

CIM 80-1

While the Act does not specifically identify patient education programs as covered

services, reimbursement may be made under Medicare for such programs furnished by

providers of services (i.e., hospitals, SNFs, HHAs, and OPT providers) to the extent that

the programs are appropriate, integral parts in the rendition of covered services which are

reasonable and necessary for the treatment of the individual’s illness or injury. For

example, educational activities carried out by nurses such as teaching patients to give

themselves injections, follow prescribed diets, administer colostomy care, administer

medical gases, and carry out other inpatient care activities may be reimbursable as a part

of covered routine nursing care. Also, the teaching by an occupational therapist of

compensatory techniques to improve a patient’s level of independence in the activities of

daily living may be reimbursed as a part of covered occupational therapy. Similarly, the

instruction of a patient in the carrying out of a maintenance program designed for him/her

by a physical therapist may be reimbursed as part of covered physical therapy.

However, when the educational activities are not closely related to the care and treatment

of the patient, such as programs directed toward instructing patients or the public

generally in preventive health care activities, reimbursement cannot be made since the

Act limits Medicare payment to covered care which is reasonable and necessary for the

treatment of an illness or injury. For example, programs designed to prevent illness by

instructing the general public in the importance of good nutritional habits, exercise

regimens, and good hygiene are not reimbursable under Medicare.