FAQ – Maintenance Therapy

Question – June 4, 2021

In what outpatient therapy settings is maintenance therapy a covered benefit under traditional Medicare?

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Question – June 4, 2021

Does traditional Medicare cover maintenance therapy in a skilled nursing facility under Part A benefits?

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Question – June 4, 2021

Does traditional Medicare cover maintenance therapy for a Medicare beneficiary receiving home health services under Part A benefits?

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Question – April 5, 2021

If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, do those visits count towards their annual therapy threshold dollar amount?

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Question – April 5, 2021

If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, do we need to apply the KX modifier to the CPT codes on the claim form if the Medicare beneficiary has exceeded their annual therapy threshold dollar amount?

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Question – December 13, 2020

Can a physical therapist assistant (PTA ) or occupational therapy assistant (OTA) provide maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services?

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Question – September 13, 2017

Does the Centers for Medicare and Medicaid Services have a web page dedicated to maintenance therapy?

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Question – September 1, 2017

Does the Jimmo Settlement Agreement apply to Medicare Advantage plans?

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Question – Updated November 12, 2015

On the claim form, how will the Medicare Administrative Contractor (MAC) know whether the therapy is rehabilitative in nature or maintenance in nature?

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Question – Updated November 12, 2015

If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, do we need to apply the KX modifier to the CPT codes on the claim form if the Medicare beneficiary has exceeded their annual therapy cap?

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Question – Updated November 12, 2015

If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, do those visits count towards their annual therapy cap?

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Question – Updated November 12, 2015

If providing maintenance therapy services to a Medicare beneficiary receiving outpatient therapy services, what CPT codes do I use to bill the Medicare program?

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Question – Posted January 25, 2014 and Reviewed November 12, 2015

What happens if the Medicare beneficiary does not have anyone to help them at home carry out the maintenance program? Can I continue to see the Medicare beneficiary and bill the Medicare program for the maintenance therapy services?

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Question – Posted January 25, 2014 and Reviewed November 12, 2015

Can an assistant carry out a maintenance program with the Medicare beneficiary and/or their family/caregiver?

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Question – Posted January 25, 2014 and Reviewed November 12, 2015

Who can establish and develop a maintenance therapy program?

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Question – Posted January 25, 2014 and Reviewed November 12, 2015

Is maintenance therapy covered in Comprehensive Outpatient Rehabilitation Facility (CORF) setting?

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Question – Posted January 25, 2014 and Reviewed November 12, 2015

In the inpatient rehabilitation facility (IRF) setting, must the patient be expected to return to their prior functional status and/or prior home situation?

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Question – Posted January 25, 2014 and Reviewed November 12, 2015

Is maintenance therapy covered in the inpatient rehabilitation facility (IRF) setting?

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Question – Posted January 25, 2014 and Reviewed November 12, 2015

What is the difference between rehabilitative therapy and maintenance therapy?

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Question – Posted January 25, 2014 and Reviewed November 12, 2015

Prior to the settlement of this lawsuit, did CMS have an “Improvement Standard” for outpatient therapy services?

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Question – Updated November 12, 2015

Why did the Medicare Advocacy Organization bring a lawsuit against CMS regarding outpatient therapy coverage issues?

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