How Old Can a Physician Order Be for Therapy Services

October 30, 2017
Rick Gawenda

A question I often receive regarding physician orders is how old can a physician order/referral for outpatient therapy be? Must therapy begin within 30 days, 60 days, 90 days, etc. of the order/referral being signed and dated by the referring physician?

For Medicare Part B therapy services, the Centers for Medicare and Medicaid Services (CMS) does

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  1. Do you know if a PT can be considered a “licensed practitioner” who can write orders for rehabilitation services according to 482.56 in a state with direct access? Could we become part of the ” medical staff” if acting within our scope of practice, referencing 2b in this section?

    1. It is a possibility. You would want to work with your hospital medical staff as well as check with your PT state board.

  2. It took me awhile to find the answer to this question for the state of VA- I contacted the PT board and they didn’t have an answer so they referred me to the pharmacy board. Based on their answer- prescriptions are valid for 1 year after the date of issue.

  3. If we choose to obtain physician orders for outpatient services, would we need one for each episode of care, or could one order suffice for a year if the person is seen for multiple episodes?

    1. You would have to defer to your state practice act as well as the rules and regulations for each insurance carrier.

  4. There is a statement in the CMS manual from 01/04/2004 under 220.3.2 (Outpatient must be under Care of Physician) stating “if the therapy service continues past the 60th day, there must be evidence in the patient’s clinical record, which is a part of the therapy documentation, that a physician or non-phys practitioner has seen him/her within 60 days after the therapy began & every 30 days past the 60th day.” My question is does the patient truly have to see the ordering physician every days 30 days after the 60 days? I know this particular manual is 2004 but I can’t find anything more current about this statement.

    Thank You!

      1. Thank you for your response. Our facility has the current Medicare policy on file that you provided a link to. I have read through this policy and best I can tell, the Certification/Re-cert policy(s) are the guiding factor for my original question? Is that correct?