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TimothyP975205
Contributor ⭐
February 1, 2024

Original Medicare Physical Therapy Coverage

  • February 1, 2024
  • 4 replies
  • 2788 views

I am wondering if anyone has run into this problem, or has any knopwledge how Medicare would cover (or not) this scenario.

 

I have a Neurological problem that cased a "Foot Drop" and the Neurologist gave me a referral for Physical.

 

I also suffer from a torn Meniscus in my knee, and my Orthopedic Doctor gave me a referral for PT to help with the pain from that.

 

The PT Office claims that Medicare will not allow me to do PT at the same visit for these 2 problems and that I have to do PT for one problems, and when that's finished, I need to start over for the second problem.

 

This sounds insane to me.  But when I contacted Medicare and asked about their policy, I could not get a straight answer. (WOW... imagine that !)

 

Thanks for your input.

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    4 replies

    cat0w
    cat0w
    Conversationalist ⭐⭐⭐
    February 3, 2024

    Have you looked at the Medicare website and what will be covered? Welcome to Medicare | Medicare 

    Check out Providers & Services> Learn>What Medicare covers.

     

    Did you receive any information from Medicare prior to the start of the new year with information about what coverage you have? 

    T
    TimothyP975205Author
    Contributor ⭐
    February 3, 2024

    Yes.  I have been on Medicare for over 5 years.  PT is most definitely covered,  but I can't get an answer if TWO separate body areas from TWO different referrals from TWO different Doctors would be allowed.

     

    I know for sure if I did them in sequence, one after the other,  they would be covered.  But I am going to the PT office anyway, so why can't I get them both addressed in one trip instead of wasting my time doing PT twice?

    GailL1
    GailL1
    Community Champion ⭐⭐⭐
    March 13, 2024

    @TimothyP975205 wrote -

    I know for sure if I did them in sequence, one after the other,  they would be covered.  But I am going to the PT office anyway, so why can't I get them both addressed in one trip instead of wasting my time doing PT twice?

    +++++++++++++++++++++++++++++++++++

    I am not so sure that this is a Medicare thing or a Physical Therapy things - IOW, it is hard to book two different therapist for two different type therapy sessions for one person.  This is especially true if you are going more than once a week for at least one type or both.

     

    I just finished my ortho PT now I am scheduled to be evaluated for the vestibular PT - not the same therapist handle both types of therapy.

     

     

    IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
    GailL1
    GailL1
    Community Champion ⭐⭐⭐
    February 5, 2024

    @TimothyP975205 

    I read your post several days ago but have just found time to reply. 

     

    There are many different type of PT.  I am having this same issue right now because I need (2) types of therapy - one ortho in nature, the other vestibular in nature; ordered by the same doctor for basically some of the same problems.  Not all therapists are trained to do both types - plus my doc want to know how the ortho rehab goes for my problems before going onto the vestibular rehab. - wants to see if it helps or if something might get worse.   I have (1) therapist that does both and then (2) others that only handle the ortho.

     

    So now I am doing ortho for another (8) weeks and then if things go as planned I will get an end evaluation for the ortho and a beginning evaluation for the vestibular and begin that type of therapy.

     

    Receiving different types of PT at the same time whether ordered by one or more physicians is problematic with Medicare because of all the mountain of verification and the following of progression that the therapist has to provide as ordered by CMS (Center for Medicare and Medicaid Services).

     

    I can only give you access to the Medicare PT Manual to see if your particular situation will work with them.  At least you will see what they are up against cause I am sure that you do want your Medicare claims to be paid.

     

    Here is the Medicare manual that covers the PT procedures 

    220 - Coverage of Outpatient Rehabilitation Therapy Services (Physical
    Therapy, Occupational Therapy, and Speech-Language Pathology
    Services) Under Medical Insurance

     

    You may have to scroll down to Section 220 -

     

    Looking up your particular type of therapies on the MCD (Medicare Coverage Determination) might also help you determine if the (2) different therapies can be completed together.  You may have to file a Medicare appeal if not.

     

    So to give you a definitive answer - you may have to fight for what you want and then still may not be able to get what you want.  It will not be quick or easy - cause you are going against the grain of their procedures.

     

    I personally don't like fighting with the government - 

     

     

    IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
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