10.09.17.04

.04 Covered Services.

A. The Physical Therapy Program covers medically necessary physical therapy services ordered in writing by a physician, doctor of dental surgery or of dental medicine, physician assistant, nurse practitioner, nurse midwife, or podiatrist when the services are:

(1) Provided by a licensed physical therapist or by a licensed physical therapist assistant under a licensed physical therapist's direct supervision;

(2) Provided in the provider's office, the patient's home, or a domiciliary level facility;

(3) Diagnostic, rehabilitative, or therapeutic, and directly related to the written treatment order;

(4) Of sufficient complexity and sophistication, or the condition of the patient is such, that the services of a physical therapist are required;

(5) Rendered pursuant to a written treatment order which:

(a) Is signed and dated by the prescriber;

(b) Specifies the following:

(i) Part or parts to be treated; and

(ii) Expected results of physical therapy treatments;

(c) Is kept on file by the therapist as a part of the patient's permanent record, subject to review by the Department or its designee; and

(d) Is not altered by the therapist unless:

(i) Medically indicated;

(ii) Signed by the therapist;

(iii) Necessary changes are made;

(iv) The prescriber is notified of the change; and

(v) The change is noted in the patient's record; and

(6) Recorded in the patient's permanent record which includes:

(a) The treatment order of the prescriber;

(b) The initial evaluation by the therapist and significant past history;

(c) All pertinent diagnoses and prognoses;

(d) Contraindications, if any; and

(e) Progress notes documented in accordance with the requirements listed in COMAR 10.38.03.02-1A(2), C, and D.

B. The Physical Therapy Program covers an initial evaluation, on a one-time-only basis, per condition, when the requirements of §A, of this regulation, are met.

C. If the prescribing order exceeds 30 days, the therapist shall request a new order from the prescriber for continued therapy.