With the expiration date of the COVID-19 Public Health Emergency (PHE) on May 11, 2023, we have reviewed and updated the following questions regarding the supervision requirements of a physical therapist assistant (PTA) by a physical therapist (PT) and an occupational therapy assistant (OTA) by an occupational therapist (OT) under Medicare Part B outpatient therapy services for calendar year 2023:
Question: What are the supervision requirements of a PTA or OTA in a non-private practice setting (submit claims on a UB-04 claim form) when they are treating a Medicare Part B beneficiary for outpatient therapy services?
Answer:
When a PTA or an OTA is treating a Medicare Part B beneficiary for outpatient physical therapy services in a non-private practice setting, the Centers for Medicare and Medicaid Services (CMS) requires general supervision of the PTA or OTA by the PT or OT, respectively.
General supervision means the physical therapist (PT) or occupational therapist (OT) does not need to be on the premise while the PTA or OTA is treating the Medicare beneficiary. They just have to be available if required.
This “availability” could occur via a phone or pager, for example. See CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, Section 230.4B for more details.
However, if your state practice act is more stringent/restrictive, then you must adhere to the supervision requirements of your state practice act.
For example, if your state practice act requires direct supervision of the PTA by the PT or the OT by the OTA, then you would need to adhere to your state practice act since it’s more stringent/restrictive than what the Medicare program requires.
Question: What are the PT supervision requirements of a PTA or OTA in a private practice setting (submit claims on a 1500 claim form) when they are treating a Medicare Part B beneficiary for outpatient therapy services?
Answer:
Under normal circumstances, the Centers for Medicare and Medicaid Services (CMS) requires the PT or OT to provide direct supervision to the PTA and OTA, respectively, when they are treating a Medicare beneficiary for outpatient therapy services in a private practice setting.
Per CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, Section 230.4B, CMS states “Direct supervision requires that the supervising private practice therapist be present in the office suite at the time the service is performed.
These direct supervision requirements apply only in the private practice setting and only for therapists and their assistants.”
Due to the COVID-19 PHE, beginning in March 2020 CMS eased the direct supervision requirements of a PTA or an OTA in the private practice setting so that direct supervision could be achieved virtually—through the use of interactive telecommunications technology—for services paid under the Medicare Physician Fee Schedule (MPFS).
Since physical and occupational outpatient therapy services are paid under the MPFS, this revised definition would apply to PTs supervising PTAs and OTs supervising OTAs in the private practice setting.
This means that a PTA or OTA could treat a Medicare Part B beneficiary in the private practice clinic or in a beneficiary’s home and the PT or OT would not need to be in the clinic or in the beneficiaries home providing the direct supervision. Instead, the PT or OT would need to be available, if needed, via interactive telecommunications technology.
For the reference, click HERE and go to Section Q: Physician Services and read Questions 2 and 6. CMS did confirm that this applies to physical and occupational therapy services. Click HERE and read pages 7-8 and 15.
The flexibility was extended in December 2020 when CMS released the calendar year 2021 final rule for services paid under the MPFS. In the final rule, CMS finalized their proposal to allow direct supervision to be provided using real-time, interactive audio and video technology (excluding telephone that does not also include video) through the later of the end of the calendar year in which the PHE ends. Therefore, the PTA/OTA supervision flexibility will remain in place until December 31, 2023.
For the rest of 2023, the supervision requirement can be met by the supervising physician (or other practitioner) being immediately available to engage via audio/video technology (excluding audio-only), and does not require real-time presence or observation of the service via interactive audio and video technology throughout the performance of the procedure.
“Other practitioner” would include a physical therapist or occupational therapist in private practice supervising a physical therapist assistant or occupational therapy assistant, respectively, if allowed by your state practice act.
To read this part in the final rule, click HERE and read pages 172-179 of the pdf version of the final rule.
If your state practice act requires direct supervision of the PTA by the PT or of the OTA by the OT and this requirement has not been eased, then you must adhere to the policy that is most restrictive or stringent. In this example, this means you would need to adhere to your state practice act.
