An Open Letter to Florida Medicare (First Coast Service Options)

This author's continued investigation into the new Medicare policy of Skilled Maintenance Therapy for Safety will be published on this blog for your edification and comment.

The following letter was sent to medical.policy@fcso.com after the normal FCSO Medicare customer service reps were stymied by my questions.

Dear Medicare Policymakers,

The new (2/2/09) LCD for Therapy & Rehab Part B services (L29289) has new instructions for physical therapists (page 21):

Skilled MAINTENANCE THERAPY for Safety

"If the services required to maintain function involve the use of complex and sophisticated therapy procedures, the judgment and skill of a therapist may be necessary for the safe and effective delivery of such services.

When the patient’s safety is at risk, those reasonable and necessary services shall be covered even if the skills of a therapist are not ordinarily needed to carry out the activities preformed as part of the maintenance program."

However, the LCD goes on to clarify the clinical situation:

"It is not medically necessary for a therapist to perform or supervise maintenance programs that do not require
the professional skills of a therapist.

These situations include...
· repetitive exercises to maintain gait or maintain strength and endurance, and assisted walking, such as that
provided in support for feeble and unstable patients;"

The most likely clinical scenario in outpatient physical therapy clinics is when the PT assess a patient likely to fall (complex and sophisticated services = skilled) on a patient whose exercises are necessarily low-level and repetitive (for feeble and unstable patients).

On the face of it, the new LCD language appears contradictory.

I wonder if you could provide some guidance?

Thank you.

Tim Richardson, PT