In this article, I will answer the following questions regarding the supervision requirements of a physical therapist assistant (PTA) by a physical therapist (PT) and an occupational therapy assistant (OTA) by an occupational therapist (OT) under Medicare Part B outpatient therapy services for calendar year 2021:
- What are the supervision requirements of a PTA or OTA in a non-private practice setting (submit claims on a UB-04 claim form) when they are treating a Medicare Part B beneficiary for outpatient therapy services?
- What are the supervision requirements of a PTA or OTA in a private practice setting (submit claims on a 1500 claim form) when they are treating a Medicare Part B beneficiary for outpatient therapy services?
Lets begin!
Question: What are the supervision requirements of a PTA or OTA in a non-private practice setting (submit claims on a UB-04 claim form) when they are treating a Medicare Part B beneficiary for outpatient therapy services?
Answer:
When a PTA or an OTA is treating a Medicare Part B beneficiary for outpatient therapy services in a non-private practice setting, the Centers for Medicare and Medicaid Services (CMS) requires general supervision of the PTA or OTA by the PT or OT, respectively. General supervision means the PT or OT does not need to be on the premise while the PTA or OTA is treating the Medicare beneficiary. They just have to be available if required. This could occur via a phone or pager, for example. See CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, Section 230.4B for more details.
However, if your respective state practice act is more stringent/restrictive, then you must adhere to your state practice act. For example, if your state practice act requires direct supervision of the PTA by the PT or the OT by the OTA, then you would need to adhere to your state practice act since it’s more stringent/restrictive than what the Medicare program requires.
Question: What are the supervision requirements of a PTA or OTA in a private practice setting (submit claims on a 1500 claim form) when they are treating a Medicare Part B beneficiary for outpatient therapy services?
Answer:
Under normal circumstances, the Centers for Medicare and Medicaid Services (CMS) requires the PT or OT to provide direct supervision to the PTA and OTA, respectively, when they are treating a Medicare beneficiary for outpatient therapy services in a private practice setting. Per CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, Section 230.4B, CMS states “Direct supervision requires that the supervising private practice therapist be present in the office suite at the time the service is performed. These direct supervision requirements apply only in the private practice setting and only for therapists and their assistants.”
Due to the Public Health Emergency (PHE) due to COVID-19, CMS has eased the direct supervision requirements of a PTA or an OTA in the private practice setting. During the PHE, CMS is revising the definition of direct supervision to include a virtual presence through the use of interactive telecommunications technology for services paid under the Medicare Physician Fee Schedule (MPFS).
Since physical and occupational outpatient therapy services are paid under the MPFS, this revised definition would apply to PTs supervising PTAs and OTs supervising OTAs in the private practice setting. This means that a PTA or OTA could treat a Medicare Part B beneficiary in the private practice clinic or in the beneficiaries home and the PT or OT would not need to be in the clinic or in the beneficiaries home providing the direct supervision. The PT or OT would need to be available, if needed, via interactive telecommunications technology.
For the reference, click HERE and go to Section Q: Physician Services and read Questions 2 and 6. CMS did confirm that this applies to physical and occupational therapy services. Click HERE and read pages 7-8 and 15. The changes to supervision rules are effective for services beginning March 1, 2020, and last for the duration of the COVID-19 PHE.
The news got even better on December 2, 2020 when CMS released the calendar year 2021 final rule for services paid under the MPFS. In the final rule, CMS finalized their proposal to allow direct supervision to be provided using real-time, interactive audio and video technology (excluding telephone that does not also include video) through the later of the end of the calendar year in which the PHE ends or December 31, 2021. For example, if the PHE ends on April 20, 2021, this revised direct supervision requirement would end on December 31, 2021. However, if the PHE did not end until January 20, 2022, this revised direct supervision requirement would end on December 31, 2022.
The requirement could be met by the supervising physician (or other practitioner) being immediately available to engage via audio/video technology (excluding audio-only), and would not require real-time presence or observation of the service via interactive audio and video technology throughout the performance of the procedure. “Other practitioner” would include a physical therapist or occupational therapist in private practice supervising a physical therapist assistant or occupational therapy assistant, respectively, if allowed by your state practice act. To read this part in the final rule, click HERE and read pages 172-179 of the pdf version of the final rule.
If your state practice act requires direct supervision of the PTA by the PT or of the OTA by the OT and this requirement has not been eased, then you must adhere to the policy that is most restrictive or stringent. In this example, this means you would need to adhere to your state practice act.
I hope you found this article informative and you now have a better understanding of the supervision requirements of an assistant in calendar year 2021 when the PTA or OTA is treating a Medicare Part B beneficiary for outpatient therapy services. If you would like to speak to me, feel free to call 661-645-1490 or email rick@gawendaseminars.com.
About Gawenda Seminars & Consulting
Gawenda Seminars & Consulting offers education and consulting in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services for physical therapy, occupational therapy, and speech therapy. In addition, Gawenda Seminars & Consulting provides a website subscription service to assist their Clients with staying current on all the changes impacting outpatient therapy services. For additional information, please go to www.gawendaseminars.com.
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