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Can I Treat Patient’s in Their Home as an Outpatient

by • May 14, 2018 • 7 Comments

Whether an insurance carrier will pay for therapy services provided in the patient’s home under their outpatient therapy benefits is the answer most people do not like; it is insurance carrier specific. Regarding the Medicare program, the Centers for Medicare and Medicaid Services (CMS) states therapy services are payable under the Medicare Physician Fee Schedule when furnished by a provider or supplier in the following settings:

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7 thoughts on “Can I Treat Patient’s in Their Home as an Outpatient”

  1. Julie Somsky says:

    Thanks for such a great summary on this topic! Much appreciated.

  2. Angela King says:

    This is great. I’ve wanted to have more information about this for a long time.

    1. Rick Gawenda says:

      You are welcome!

  3. Linda Lucuski says:

    Hello Rick;
    We have a patient who is currently receiving Home Care under Medicare Part B (through an agency not connected with our hospital) for a diagnosis of Parkinson’s disease. This individual also needs Lymphedema evaluation and treatment and would need to come to our hospital outpatient facility for this treatment. Can we bill Medicare B for the lymphedema services to be recevied at our hospital based outpatient center on a different day than the individual is receiving Med B physical therapy services in the home? Thank you.

    1. Rick Gawenda says:

      This would be considered a Medicare patient receiving outpatient therapy at 2 different facilities during the same time period. CMS does not prohibit this from occurring.

  4. Michael Fyffe says:

    There are additional Modifier needed for tx locations, Clinic, ALF and Clients Home. Is

    1. Rick Gawenda says:

      There are no special modifiers required. On a 1500-claim form, the place of service code would be different.

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