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Home Health,PT & Self Pay. Is it legal?

  1. #1
    Default Home Health,PT & Self Pay. Is it legal?
    Medical Coding Books
    Have a question. Is it legal to allow a Medicare patient to come in for physical therapy as a self pay, that is on home health and not send the claim to Medicare?

    This particular patient is on home health after suffering a broken spine & is learning to get out of a wheelchair however in her fall her tailbone was broken. She is not receiving PT for the tailbone as the home health agency cannot treat it so her husband wants her to receive PT on her tailbone & wants to pay cash! Need the rules if anyone has encountered this. Thanks.

  2. #2
    Swainsboro/Statesboro, GA
    Default Lots of issues to consider
    Hey Dgamgirl,

    There are several things to consider in your example. First, the patient must have an order and Plan of Care from a physician for the tailbone PT.

    Second, when a patient is under Home Health, they are allowed to leave the house for medical appointments, so going to PT would probably qualify for this.

    Third, the PT needed for the tailbone injury is not something the Home Health agency is able to provide, and if this does need therapy (as per the physician order), then it is likely this could meet medical necessity and be a covered service.

    I would check with your FI, Carrier or MAC. This does sound like it could very well be covered and therefore billable to Medicare.

    I would be interested in hearing the outcome!

    Freda Brinson, CPC, CPC-H
    2009-2011 AAPCCA Board Member
    2009 Education Officer, Savannah, GA Chapter

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