Outpatient therapy services furnished to a Medicare beneficiary by a therapy provider are payable only when furnished in accordance with certain conditions. Among the Conditions is the requirement that a Plan of Care for furnishing therapy services has been established by a physician/NPP or by the therapist providing therapy services.
For outpatient therapy by a Part B supplier including physical therapists, occupational therapists, and speech-language pathologists in private practice, or in a physician’s office the Plan is generally established by the evaluating therapists. A therapist in a Rehab Agency, hospital outpatient department, SNF Part B, or Home Health Agency Part B can also establish the Plan.
However a physician/NPP may also establish the Plan of Care, while not the norm in outpatient therapy, it is acceptable. For Comprehensive Outpatient Rehabilitation Facilities (CORF) that provide pulmonary therapy, the Plan may only be established by the physician.
See Medicare Benefits Policy Manual, Chapter 15, Sec. 220.1 Conditions of Coverage and Payment.