Md. Code Regs. 10.14.02.07

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.14.02.07 - Physical Therapy Services

A. To be considered a participating physical therapist in the Program, the provider shall:

(1) Be a physical therapist licensed to practice physical therapy in Maryland or a jurisdiction bordering Maryland;

(2) Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated Departmental form;

(3) Follow standard health and safety procedures to protect an eligible patient from potential hazards;

(4) Agree to the medical and reporting requirements of the Program pursuant to Regulation .04A(5), (9), and (10) of this chapter;

(5) Agree to accept, as payment in full, the amount paid by the Program pursuant to §E of this regulation plus the amount paid by the eligible patient's health insurer, if applicable; and

(6) Agree not to bill an eligible patient an additional charge for the covered service.

B. The Program shall reimburse a participating physical therapist for a medically necessary physical therapy service ordered in writing by a participating physician when the service is:

(1) Provided by a physical therapist or by a physical therapist assistant under the direct supervision of a physical therapist;

(2) Provided in a physical therapy office or the patient's home;

(3) Considered one or more of the following:

(a) Diagnostic;

(b) Rehabilitative; or

(c) Therapeutic;

(4) Directly related to the written treatment order;

(5) Of sufficient complexity and sophistication, or the condition of the patient is such that the service of a physical therapist is required;

(6) Rendered pursuant to a written treatment order which:

(a) Is signed and dated by the prescribing physician;

(b) Specifies the following:

(i) Body part to be treated;

(ii) Type of modality or treatment to be rendered;

(iii) Expected result of physical therapy treatment; and

(iv) Frequency and duration of treatment;

(c) Is kept on file by the physical therapist as a part of the permanent patient record subject to review by the Department or its designee;

(d) Is not altered by the physical therapist unless medically indicated, whereby the physical therapist shall make a necessary change and sign the treatment order, advising the prescribing physician of the change and noting it in the patient record;

(7) Recorded in the permanent record to include the following:

(a) The treatment order;

(b) The initial evaluation by the physical therapist;

(c) Significant past history;

(d) Pertinent diagnoses and prognoses;

(e) Contraindications, if applicable; and

(f) Progress notes, at least once every 2 weeks;

(8) For a written treatment order for treatment exceeding 30 days and the participating physician:

(a) Reviews and rewrites the order monthly; or

(b) Initials and dates a copy of the original order monthly; and

(9) For an initial physical therapy evaluation, on a one-time basis, per condition, when the requirements of this regulation are met.

C. The Program does not reimburse for services:

(1) Performed by a physical therapy assistant when not under the direct supervision of the physical therapist;

(2) Performed by a physical therapy aide; or

(3) Not directly related to the treatment of breast and cervical cancer.

D. The participating physical therapist is responsible for the following:

(1) Submitting to the Department, within 12 months of the date of service, a request for payment on the designated form;

(2) Certifying on the invoice that the treatment order is on file and was in effect at the time that services were rendered; and

(3) Specifying on the invoice the type of treatment provided.

E. Reimbursement Principles.

(1) The Department shall reimburse the participating physical therapist:

(a) The current Medical Assistance approved rate in the State for a covered service performed in the provider's office for an eligible patient who is uninsured or has insurance that does not provide coverage for the reimbursed procedure or service;

(b) The outstanding deductible and patient contribution for a covered service performed in the provider's office for an eligible patient who has Medicare or other insurance that provides reimbursement for a covered procedure or service; and

(c) For covered services performed in the home of an eligible patient pursuant to Regulation .11F of this chapter.

(2) The Department may not reimburse the participating physical therapist for:

(a) Services rendered by mail or telephone;

(b) Completion of a form or report;

(c) A broken or missed appointment; or

(d) A service which is provided at no charge to the general public.

F.The participating physical therapist shall obtain recovery pursuant to Regulation .17 of this chapter.

G. The Program shall reimburse for claims submitted pursuant to this regulation as set forth in Regulation .21 of this chapter.

Md. Code Regs. 10.14.02.07

Regulations .07 under new Chapter, Reimbursement for Breast and Cervical Cancer Diagnosis and Treatment, adopted as an emergency provision effective March 31, 1993 (20:8 Md. R. 715);
Regulations .07 adopted effective December 5, 1994 (21:24 Md. R. 1988)
Regulation .07F amended as an emergency provision effective January 1, 2014 (41:2 Md. R. 88); amended permanently effective May 12, 2014 (41:9 Md. R. 521)
Regulations .07 amended effective 42:7 Md. R. 569, eff.4/13/2015; amended effective 47:10 Md. R. 515, eff. 5/18/2020