Documenting Medical Necessity for Palliative Care and Degenerative or Chronic Conditions

Abstract

Recently, the Centers for Medicare & Medicaid Services (CMS) clarified that an expectation for functional or clinical improvement was not a requirement to receive payment for physical therapy services. This includes many life-threatening, chronic, or degenerative conditions. This clarification requires a different approach to clinical documentation and clinical decision-making. The onus rests on the physical therapist and the physical therapist assistant to clearly document medical necessity and that interventions required the skill of a physical therapist. Many other private insurance providers still require an expectation of clinical improvement to justify payment for physical therapy.