Outpatient Therapy in the Home: FAQs

August 23, 2021
 / 
Rick Gawenda
 / 

With an increase in private practices, especially solo practices, providing outpatient therapy in a patient’s home, I am receiving more and more questions regarding the regulatory, billing and payment rules. In addition, due to COVID-19, rehabilitation agencies and hospital outpatient therapy departments are sending their therapists to a patient’s home to provide outpatient therapy services. In this article, I will provide answers to the following questions:

  1. Does the Medicare program pay for outpatient therapy provided in a beneficiaries home?
  2. For Medicare purposes, what is considered a patient’s home?
  3. Do Medicare Advantage plans and commercial insurance carriers pay for outpatient therapy provided in a patient’s home?
  4. Must I document that the outpatient therapy was provided in the patient’s home?
  5. Are there any differences in the required documentation if a patient is seen in their home versus attending therapy at a physical location?
  6. Are there any differences in the required billing if a patient is seen in their home versus attending therapy at a physical location?
  7. Is there a modifier that needs to be appended to each CPT code on the claim form to indicate the services were provided in a beneficiaries home?
  8. On the 1500-claim form, what do I use for the place of service code?
  9. On the UB-04 claim form, what do I use for the place of service code?
  10. Are the supervision requirements of a physical therapist assistant or occupational therapy assistant different if the outpatient therapy was provided in a patient’s home versus the patient attending outpatient therapy at a physical location?
  11. If you accept Medicare and cash, can you charge your cash-pay patients a differential (e.g., mileage) for home visits versus telehealth?
  12. If you have a specific and clearly stated travel mileage range for your practice, can you charge an additional travel fee for clients outside the range?
  13. Can a Medicare patient be seen in a clinic for one discipline and outpatient in the home for another discipline and does MPPR apply?
  14. Under Medicare Part B, can a physical therapist assistant or occupational therapy assistant who are employed by a private practice see Medicare patients in their home for outpatient therapy once evaluated by the therapist?
  15. Under Medicare Part B, can a physical therapist assistant or occupational therapy assistant who are employed by a non-private practice (rehab agency, hospital outpatient therapy department, etc.) see Medicare patients in their home for outpatient therapy once evaluated by the therapist?
  16. Can you charge a Medicare beneficiary a travel fee to see them in their home?
  17. Can you charge a Medicare Advantage patient a travel fee to see them in their home?
  18. Can you charge a patient who as a commercial insurance a travel fee to see them in their home?
  19. If I see a patient for outpatient therapy in their home and they have a pool on their property, can I provide and bill for aquatic therapy?
  20. If I see a patient for outpatient therapy in their home and they have a community pool, can I take the patient to the community pool and provide and bill for aquatic therapy?
  21. Can I alternate seeing a patient in their home and in a clinic setting for outpatient therapy?
  22. What’s the allowed minimum or maximum of frequencies of treatment if seeing a patient in their home for outpatient therapy?
  23. If I enrolled in Medicare as a private practice and on the 855I enrollment form, answered no to the question of “Do you ONLY render PT/OT services in the patients’ home? and answered yes to the questions “Do you maintain private office space?” and “Do you own, lease, or rent your private office space?”, can I still see Medicare patients in their home without updating my Medicare enrollment?
  24. Does the COVID-19 Public Health Emergency have anything to do with a private practice or facility setting with providing outpatient therapy in a Medicare beneficiaries home?

Let’s begin!

Question #1
Does the Medicare program pay for outpatient therapy provided in a beneficiaries home?

Answer #1

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Question #2
For Medicare purposes, what is considered a patient’s home?

Answer #2

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Question #3
Do Medicare Advantage plans and commercial insurance carriers pay for outpatient therapy provided in a patient’s home?

Answer #3

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Question #4
Must I document that the outpatient therapy was provided in the patient’s home?

Answer #4

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Question #5
Are there any differences in the required documentation if a patient is seen in their home versus attending therapy at a physical location?

Answer #5

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Question #6
Are there any differences in the required billing if a patient is seen in their home versus attending therapy at a physical location?

Answer #6

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Question #7
Is there a modifier that needs to be appended to each CPT code on the claim form to indicate the services were provided in a beneficiaries home?

Answer #7

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Question #8
On the 1500-claim form, what do I use for the place of service code?

Answer #8

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Question #9
On the UB-04 claim form, what do I use for the place of service code?

Answer #9

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Question #10
Are the supervision requirements of a physical therapist assistant (PTA) or occupational therapy assistant (OTA) different if the outpatient therapy was provided in a patient’s home versus the patient attending outpatient therapy at a physical location?

Answer #10

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Question #11
If you accept Medicare and cash for all other patients, can you charge your cash-pay patients a differential (e.g., mileage) for home visits versus telehealth?

Answer #11

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Question #12
If you have a specific and clearly stated travel mileage range for your practice, can you charge an additional travel fee for clients outside the range?

Answer #12

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Question #13
Can a Medicare patient be seen in a clinic for one discipline and outpatient in the home for another discipline and does MPPR apply?

Answer #13

The content here is for members only log in here or sign up.

Question #14
Under Medicare Part B, can a physical therapist assistant or occupational therapy assistant who are employed by a private practice see Medicare patients in their home for outpatient therapy once evaluated by the therapist?

Answer #14

The content here is for members only log in here or sign up.

Question #15
Under Medicare Part B, can a physical therapist assistant (PTA) or occupational therapy assistant (OTA) who are employed by a non-private practice (rehab agency, hospital outpatient therapy department, etc.) see Medicare patients in their home for outpatient therapy once evaluated by the therapist?

Answer #15

The content here is for members only log in here or sign up.

Question #16
Can you charge a Medicare beneficiary a travel fee to see them in their home?

Answer #16

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Question #17
Can you charge a Medicare Advantage (MA) patient a travel fee to see them in their home?

Answer #17

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Question #18
Can you charge a patient who as a commercial insurance a travel fee to see them in their home?

Answer #18

The content here is for members only log in here or sign up.

Question #19
If I see a patient for outpatient therapy in their home and they have a pool on their property, can I provide and bill for aquatic therapy?

Answer #19

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Question #20

The content here is for members only log in here or sign up.

Question #21
Can I alternate seeing a patient in their home and in a clinic setting for outpatient therapy?

Answer #21

The content here is for members only log in here or sign up.

Question #22
What’s the allowed minimum or maximum of frequencies of treatment if seeing a patient in their home for outpatient therapy?

Answer #22

The content here is for members only log in here or sign up.

Question #23
If I enrolled in Medicare as a private practice and on the 855I enrollment form, answered no to the question of “Do you ONLY render PT/OT services in the patients’ home? and answered yes to the questions “Do you maintain private office space?” and “Do you own, lease, or rent your private office space?”, can I still see Medicare patients in their home without updating my Medicare enrollment?

Answer #23

The content here is for members only log in here or sign up.

Question #24
Does the COVID-19 Public Health Emergency (PHE) have anything to do with a private practice or facility setting with providing outpatient therapy in a Medicare beneficiaries home?

Answer #24

The content here is for members only log in here or sign up.

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All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.


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.

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  1. Thank you for fielding this topic. What are the billing differences between PT in the patient’s home provided by a home health agency vs that provided by outpatient provider? Does it make a difference whether the patient is considered homebound or not? Thank you again.

    1. Outpatient therapy billing provided by a home health agency is the same as all other OP therapy settings. If the patient is homebound and receiving home health services, completely different payment methodology.

  2. Thank You for providing such a great resources, I have a question here, In this setting, If PT is not able to be present in person, Can PT do Telehealth session while PTA is present in person to update POC, Progress report or Discharge? If yes how should it be documented e,g, Collaborated Treatment, Physical performance code done by PT virtually with 95 modifier and rest of the treatment done by PTA with CQ modifier. Progress report Assessment documented by PT.

  3. Can you give any input on how this would apply to a Critical Access Hospital? To my knowledge there are some restrictions as far as what can be offered off the grounds our outside of the radius of the CAH, which includes OP therapy in the home (unless home bound). Thank you!

  4. In response to question and answer 3……..I’m a mobile clinic and use my home. Therefore I do not have a brick and mortar physical location. All the MA plans I’ve spoken with will not credential me because of this. Is this correct? Any insight for me?

    1. I know of mobile practices that are enrolled in MA plans. My opinion is that whoever you are speaking with does not understand a mobile therapy practice providing outpatient therapy in a patient’s home.

  5. Is there a distance limitation for how far away you can travel to a patients home in relation to your therapy clinic location?