Maintenance Therapy under the Medicare Program


It has been over 5 years since the Centers for Medicare and Medicaid Services (CMS) issued revised portions of the various CMS manuals pertaining to home health, inpatient rehabilitation facilities, skilled nursing facilities, and outpatient therapy settings and the coverage of maintenance therapy in those settings; however, I still receive questions of what is maintenance therapy, when is it covered by the Medicare program, in what settings is it covered, and who can provide maintenance therapy as it applies to therapy services. This webinar will answer those 4 questions plus much much more.  Click below to learn more about the course objectives or to purchase by credit card or check.

Category: SKU: N/A


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To pay by check, please fill out the REGISTRATION FORM BY CHECK and submit with your payment to the address on the form. If you have any questions, please contact Michelle at 661.350.6187. 


In accordance with the Jimmo v. Sebelius Settlement Agreement, the Centers for Medicare & Medicaid Services (CMS) issued revised portions of the relevant chapters of the program manual used by Medicare contractors in January 2014, in order to clarify that coverage of skilled therapy services “…does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.”

This 1.5 hour webinar will explain the significant aspects of the manual changes that include:

• No “Improvement Standard” is to be applied in determining Medicare coverage for maintenance claims that require
skilled care
• Enhanced guidance on appropriate documentation
• Nothing in this Settlement Agreement modifies, contracts, or expands the existing eligibility requirements for receiving
Medicare coverage
• Skilled therapy services versus non-skilled therapy services

The webinar will discuss maintenance therapy with examples in the following settings:

• Home Health
• Skilled Nursing Facility
• Inpatient Rehabilitation Facility
• Outpatient settings including private practice, hospital outpatient departments, rehabilitation agencies, and skilled nursing


At the conclusion of this webinar presentation, participants will:

1. Identify when maintenance therapy services can be a covered benefit by the Medicare program
2. Recite the settings where functional improvement must occur for payment to occur and settings where functional
improvement is not required for payment
3. Define difference between rehabilitative therapy and maintenance therapy
4. Describe how documentation can support skilled care was required and provided
5. Understand how maintenance therapy impacts the annual therapy threshold
6. Be able to explain how to bill for maintenance therapy on your respective claim forms


Rick Gawenda, P.T., graduated in 1991 with a Bachelor of Science in Physical Therapy from Wayne State University, Detroit, Michigan. Mr. Gawenda is currently the President and founder of Gawenda Seminars & Consulting, Inc. and Director of Finances for Kinetix Advanced Physical Therapy Inc., a private practice located in southern California. He has provided valuable education and consulting to hospitals, rehabilitation agencies, private practices, nursing homes, and his peers in the areas of CPT and ICD-10 coding, billing, documentation, reimbursement, and compliance as it pertains to outpatient therapy services as well as denial management and the appeals process for Medicare denied claims. Mr. Gawenda’s website,, provides a valuable source of information on rehabilitation rules and regulations, coding, documentation, and reimbursement.

Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is the Past President of the Section on Health Policy & Administration of the APTA as well as Past President of the Michigan Association of Medical Rehabilitation Program Administrators.

Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.


Physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists, private practice owners and practice administrators, coders and office managers at private practices, as well as directors, managers, supervisors, compliance officers, risk managers, and billers in skilled nursing facilities, hospital outpatient therapy departments, schools, rehabilitation agencies, home health agencies, and comprehensive outpatient rehabilitation facilities.


In addition to the expertise and advice presented during this webinar conference, you’ll also receive a handout (in PDF format) that will include related references.


A certificate of attendance will be available upon purchase of the webinar and may be adequate for credit in some states; you will need to contact your state licensing regulatory body to determine whether or not credit will be granted for this webinar conference listened to via a CD of the live presentation that occurred on April 17, 2019.


Time:  Approximately 1 hour and 39 minutes  (including Q&A time recorded)


There are no refunds once your order has been processed since the handouts/links will be emailed to you immediately after your order has been completed. CD’s will be mailed the following business day by regular US mail.

System Requirements Required To View Webinar Playback Link On Computer:

Venue system requirements:

  • Microsoft Internet Explorer 7+, Mozilla Firefox 2.5+, Safari, or Chrome
  • 1024 x 768 screen resolution
  • Stable Internet connection, DSL or above
  • Wired Internet connection; wireless is not recommended
  • Flash Player 9 or higher
  • Disabled pop-up blockers
  • Computer speakers for participants

Note:  Android Smart Phones (i.e. IPhone) are not compatible.

In order to ensure successful connection to the playback webinar link, please take a moment to conduct a system test by clicking this link:

***Application Sharing does not need to be operational in order to view this webinar playback link.


*** This WEBINAR PLAYBACK LINK/CD and HANDOUTS  is not to be distributed outside of your organization. If you have a larger organization and have multiple locations, then please contact us at for pricing.


If you have questions about registration or logistics for this webinar conference, please contact the Webinar Conference Manager:

Michelle Gawenda at 661.350.6187 or contact Rick or Michelle via email by filling out our contact form.