A question I often receive is can a new graduate physical therapist or graduate physical therapist assistant treat Medicare patients while they are waiting to take their national examination and have their services supervised by a licensed physical therapist (PT) or physical therapist assistant (PTA) and billed to the Medicare program? Does the Centers for Medicare and Medicaid Services (CMS) answer this question and if yes, where is the answer? In this article, when I mention Medicare, I am referring to traditional Medicare and not Medicare Advantage plans.
Yes, CMS does answer this question and the answer can be found
The content here is for members only log in here or sign up.
All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
Is this only for Medicare part B or does it apply to both A and B?
The requirements of a PT and PTA can apply to both Part A and Part B services.
Can a graduating PT who hasn’t taken the licensing exam yet, (but has a limited permit to practice ), bill PT services to Medicare part b under the hospital NPI number? and is a “temporary license” the same as a “limited permit”?
No since they have not taken and passed the national licensing exam.
It has been our experience that even I newly licensed PT cannot treat Medicare patients and have another PT co-sign notes. According to Medicare the PT must be credentialed with Medicare before rendering services to a Medicare recipient. Medicare does not allow another PT to supervise a licensed PT seeing a Medicare recipient and pay for those services rendered by the uncredentialled PT. This has been a learning issue that cost us $$$ in the past. We now require every PT that wishes to work in our clinic to be credentialed with Medicare at minimum since we have an approximate 58% Medicare caseload.
Conversely, we have hired new graduate/newly licensed PTA’s and had no problem allowing them to see Medicare patients for a portion of their treatment, within the guidelines of Medicare. The supervising PT is ultimately responsible for the services rendered by the PTA.
I hope this helps some of your members in making a decision that could be costly down the road if not aware of this Medicare issue.
Randy Veroline, President/CEO
Pro Motion Rehab, Inc.
Please read Section 230.4B of the link below. I would have used this to dispute with your MAC.
The therapy services must be provided either by or under the direct supervision of the TPP. Each TPP should be enrolled as a Medicare provider. If a therapist is not enrolled, the services of that therapist must be directly supervised by an enrolled therapist. Direct
supervision requires that the supervising private practice therapist be present in the office suite at the time the service is performed.
Would a graduate PT require on-site supervision, or telecommunications be OK? Our practice act states “supervision” with no further definition.
This is not a question I can answer in this forum as there are several questions I would have to ask to be able to give you an answer or guide you to the correct resource. Due to possible legal issues, this would fall under my consulting services. You can also search for articles under “Current News” on my website. Here is a link to an article I wrote in 2019: https://gawendaseminars.com/can-new-pt-and-pta-graduates-treat-medicare-patients/
Can a new graduate who has taken and received notification that they passed the exam treat and bill Medicare while they are waiting for the state to assign their license number? In our state, the time between notification of passing the exam and issuance of license is about six weeks.
You first need to get them a NPI number but you will need their license number.