CMS Pub. 100-03, ch. 1, § 240.7

CIM 35-15

In most cases, postural drainage procedures and pulmonary exercises can be carried out safely and

effectively by nursing personnel. However, in some cases patients may have acute or severe pulmonary

conditions involving complex situations in which these procedures or exercises require the knowledge and

skills of a physical therapist or a respiratory therapist. Therefore, if the attending physician determines as

part of his/her plan of treatment that for the safe and effective administration of such services the procedures

or exercises in question need to be performed by a physical therapist, the services of such a therapist

constitute covered physical therapy when provided as an inpatient hospital service, extended care service,

home health service, or outpatient physical therapy service.

NOTE: Physical therapy furnished in the outpatient department of a hospital is covered under the outpatient

physical therapy benefit.

If the attending physician determines that the services should be performed by a respiratory therapist, the

services of such a therapist constitute covered respiratory therapy when provided as an inpatient hospital

service, outpatient hospital service, or extended care service, assuming that such services are furnished to the

skilled nursing facility by a hospital with which the facility has a transfer agreement. Since the services of a

respiratory therapist are not covered under the home health benefit, payment may not be made under the

home health benefit for visits by a respiratory therapist to a patient’s home to provide such services.

Postural drainage procedures and pulmonary exercises are also covered when furnished by a physical

therapist or a respiratory therapist as incident to a physician’s professional service.

Cross references:

The Medicare Benefit Policy Manual, Chapter 6, “Hospital Services Covered Under Part B,” §§20.

The Medicare Benefit Policy Manual, Chapter 7, “Home Health Services,” §20.

The Medicare Benefit Policy Manual, Chapter 8, “Coverage of Extended Care (SNF) Services Under Health

Insurance,” §50.

The Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health Services,” §60.2.