Physical therapy is the treatment of functional limitations to prevent the onset or to retard the progression of physical impairments following illness or injury. Medicare pays for physical therapy in at least two contexts

I. Through the Part A hospital insurance benefit, Medicare pays for physical therapy as a component of skilled nursing care, in either the acute care setting or in a post-hospital skilled nursing facility. In order to qualify for reimbursement, such therapy must meet the criteria for skilled nursing care under 42 U.S.C. – 1495i. In order to qualify, a patient otherwise appropriate for Medicare must show a qualifying hospital stay of three or more days within the 30 days prior to entering the skilled nursing facility. A physician must order procedures for the patient that are appropriate to be performed only in a Skilled Nursing Facility (SNF), such as rehabilitative therapy, and must certify that the patient’s condition is such that he or she can practically be cared for only in a SNF. In so certifying, the physician must determine that the patient’s condition should improve or achieve stability in response to curative care. The SNF medical staff is required to write a plan of care for each skilled nursing patient based upon the individual’s needs and circumstances. Upon satisfaction of those requirements, Medicare will pay for 100 days of skilled nursing care per-patient per-illness period – though after the first 20 days a co-payment of 20% is required of the patient. Once a patient qualifies, Medicare bears all expenses of the skilled nursing facility, including the patient’s custodial care and room and board (custodial care is not otherwise covered by Medicare). Typically, an SNF receives approximately $650 per day from Medicare for a qualifying skilled nursing patient. » Read more: Medicare Therapy Fraud – How to Combat Physical Therapy and Occupational Therapy False Claims