Current through Register Vol. 56, No. 18, September 16, 2024
(a) Physical
therapy services, when prescribed by a chiropractor under his or her scope of
practice (see
13:44E-2.12) shall be reimbursed
to an approved provider, in accordance with this section. Providers shall
secure prior authorization from the Division or its authorized agent when
physical therapy services are provided, except when the services are provided
in a hospital outpatient setting. Initial and subsequent prior authorization
shall not exceed 60 calendar days. Chiropractors shall not be reimbursed
directly for physical therapy services.
(b) Physical therapy services are authorized
only under the following conditions:
1. When
the chiropractor, in written communication with the physical therapist,
prescribes through detailed orders which shall be placed on the patient's chart
prior to the physical therapy treatment being initiated. These orders shall
include a statement covering the medical necessity for therapy, the objectives
of the treatment, a therapy prescription including the specific means and
methods to be used, and the estimated number and frequency of treatments.
i. Physical therapy services shall be
definitive as to type and scope of procedures to be provided. General
prescriptions such as "physical therapy three times a week," "physical therapy,
as needed," or similarly worded blanket authorization shall not be accepted by
Medicaid as a legitimate prescription since no treatment is named and the
physical therapist is in effect prescribing the patient's regime.
2. The chiropractor shall instruct
the physical therapist to file notes in the patient's chart, at least weekly,
reflecting the patient's response to treatment. These notes shall be forwarded
to the referring chiropractor in order for the chiropractor to coordinate the
plan of care and document appropriately in the patient's record, as required by
N.J.A.C. 13:44E.
3. The
chiropractor shall coordinate physical therapy with the attending physician's
plan of care in a nursing facility (see N.J.A.C. 10:63-2.4 and 2.12.)
4. Formal physical therapy is not indicated
when evidence indicates that similar types of care could be provided by the
nursing unit by rehabilitative nursing or other techniques.
(c) Physical therapy services
shall not include physical medicine procedures administered directly by a
physician, or physical therapy which is purely palliative, such as the
application of heat per se, in any form, massage, routine calisthenics or group
exercises, assistance in any activity, or use of a simple mechanical device not
requiring the special skill of a qualified physical therapist (see
13:44E-2.12) .
1. Physical therapy shall be related to the
active treatment regime designed by the chiropractor to elevate the patient to
his maximum level of functions which has been lost or reduced by reason of
injury or illness.
2. Restorative
nursing care, as distinct from physical therapy, as a prescribed service by the
chiropractor, may be provided under the following conditions:
i. These include measures as maintaining good
alignment and proper positioning of bedfast patients, keeping patients active
and out of bed in accordance with the chiropractor's orders, and developing the
patient's independence in activities of daily living by teaching self-care,
transfer and ambulation activities by the nursing staff. Restorative nursing
procedures performed by licensed nurses constitute a part of skilled nursing
care when they are prescribed by a chiropractor and are designed to restore
functions which have been lost or reduced by illness or injury.
ii. Restorative nursing services, though
prescribed by the chiropractor, are not reimbursed directly to the
chiropractor.
