Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1249 - HOME HEALTH AGENCY SERVICES
PAYMENT FOR HOME HEALTH SERVICES
Section 1249.56 - Payment conditions for physical therapy, occupational therapy, speech pathology and audiology services

Universal Citation: 55 PA Code ยง 1249.56

Current through Register Vol. 54, No. 12, March 23, 2024

Home health agencies are reimbursed for physical therapy, occupational therapy, speech therapy and audiology services if the following conditions are met:

(1) The service is prescribed by the recipient's attending physician.

(2) The service is performed by a physical therapist, occupational therapist, speech therapist or audiologist currently licensed to practice in this Commonwealth.

(3) The service is reasonable and necessary for the treatment of the recipient's illness or injury. To be considered reasonable and necessary, the services furnished shall be:

(i) Consistent with the recipient's particular medical needs as ordered by the recipient's attending physician.

(ii) Consistent with accepted standards of medical practice.

The provisions of this § 1249.56 amended under sections 403(a) and (b), 443.2(2) and 509 of the Public Welfare Code (62 P. S. §§ 403(a) and (b), 443.2(2) and 509).

This section cited in 55 Pa. Code § 1249.51 (relating to general payment policy).

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