Article adapted with permission from Melissa Fox, PT, DPT, University of Virginia Health System.
There are times when a short course of physical therapy (PT) can meet your current needs, and you can then continue exercises on your own. Other times, however, ongoing PT may be necessary to maintain your current status (strength, flexibility, mobility, etc.) and to prevent further deterioration of your condition.
A common misconception is that Medicare will only cover PT when a patient is improving (getting stronger, moving more independently, gaining flexibility). Often physical therapists discharge patients [with chronic, degenerative conditions] because they do not realize that ongoing skilled maintenance therapy is covered by Medicare.
Actually, Medicare can cover ongoing PT if you therapist feels that such therapy is needed to maintain your current function and slow your decline. If that is the case, instead of discharging you from PT, there are two options:
- The therapist can give you a home program, but continue to periodically re-evaluate you, address new needs, and modify your home program, or
- The therapist can personally provide ongoing skilled maintenance therapy due to safety and/or complexity of your situation.
In both cases, the therapist will need to document justification for ongoing PT, in order for Medicare to cover it. I have created a handout that you can provide to your PT, which details coverage, documentation, Medicare resources, American Physical Therapy Association resources, etc.
Your physical therapist is the one who should decide if you would benefit from ongoing maintenance physical therapy. The information provided above is general in nature, not specific to your situation. Your personal physical therapist may decide that you would not benefit from ongoing services, or that they cannot provide this.
Visit the Center for Medicare Advocacy for self-help packets for clients who have experienced therapy denials.