Physical therapy is an important part of the recovery process. Unfortunately there are some guidelines that are often misconstrued. When it comes to physical therapy, what are the limits?

Limit of Visits

In some instances patients receive word that ‘Medicare will only allow a set number of visits’. Not only is this misleading but it is a lie. The number of visits are not the limiting factor, rather the funding. Medicare sets a new guideline each year as it relates to skilled services such as physical therapy. The guidelines refers to the amount of money that is allocated to a patient before documentation is required to show medical necessity. Unfortunately, there are organizations that will make it known to patients that they have reached their limit as it relates to visits. This will never be the case, the amount of money prior to documentation may have been used but there will not be a set number of visits per Medicare guidelines.

Medical Necessity

Services such as physical therapy are provided by skilled practitioners. As the recovery process continues, physical therapy limits may come about. That is, when a patients recovery costs exceed $2,110 organizations must submit documentation for continued support. The organization is responsible for indicating how and why the services provided are medically necessary. At that point, therapy will continue until the benchmark goals have been reached.

Is Therapy a Maintenance Service?

Physical therapy especially within the home setting under home health care is not a maintenance setting. The same goes for outpatient therapy. Skilled services such as physical therapy are designed to promote normal functioning once again. These services are utilized after injury or illness. As the progress continues and cap limits are reached individuals will be discharged from therapy. From there, the patient must seek alternatives should they wish to maintain or continue their progress.