Provider Requirements and Service Limitations
From The July 2007 Florida Medicaid Provider Handbook
Physical Therapy - Requirements To Receive
Physical therapy is a service prescribed by a physician that is necessary to
produce specific functional outcomes in ambulation, muscle control, and
postural development and to prevent or reduce further physical disability.
The service may also include a physical therapy assessment, which does not
require a physician's prescription. In addition, this service may include training
and monitoring direct care staff and caregivers to ensure they are carrying out
therapy goals correctly.
Physical therapy and assessment services are available through the Medicaid
Therapy Services Program state plan services to recipients under the age of
21. Services for these recipients may not be purchased under the waiver.
Children who receive this service through a school health program are still
eligible for medically-necessary services funded by the Medicaid Therapy
Services Program state plan coverage. When additional therapy is necessary,
families must seek Medicaid Therapy Program state plan services. Refer to the
Florida Medicaid Therapy Services Coverage and Limitations Handbook for
additional information on Medicaid state plan coverage.
Adults may receive up to $1,500 annually in outpatient services under the
Medicaid Hospital Program state plan services, including physical therapy. If
the recipient is able to use a hospital outpatient facility for physical therapy and
the setting is appropriate to meet the recipient’s needs, it may be possible to
receive limited services funded by the Medicaid Hospital Program state plan
The waiver should only be used to fund physical therapy services for adults
either when the outpatient dollar limits are reached or when physical therapy
must be provided in a location other than a hospital outpatient facility.
A recipient shall receive no more than eight units of therapy service per day. A
unit is defined as a 15-minute time period or portion thereof. The physical
therapy assessment is limited to one per year.
Note: The Florida Medicaid Therapy Services Coverage and Limitations
Handbook and the Florida Medicaid Hospital Services Handbook are available
on the Medicaid fiscal agent’s Web Portal at http://mymedicaid-florida.com.
Click on Public Information for Providers, then on Provider Support, and then
on Provider Handbooks. The therapy handbook is incorporated by reference in
59G-4.320, F.A.C. and the hospital handbook in 59G-4.160, F.A.C.
Reimbursement* and monitoring documentation to be maintained by the provider:
1. *Copy of claim(s) submitted for payment;
2. *Copy of service log;
3. *Monthly summary note;
4. *Assessment report (if requesting reimbursement for assessment).
5. Annual report; and
Original prescription for the service.
Documentation to be submitted to the waiver support coordinator by the provider:
1. Copy of service log, monthly;
2. Copy of assessment report;
3. Copy of annual report prior to the annual support plan update; and
4. Copy of original prescription for the service.
*Indicates reimbursement documentation.
Place of Service
This service may be provided in the therapist's office, recipient’s residence, or
anywhere in the community.
Physical Therapy Provider Requirements
Physical Therapy Provider Requirements
Providers of physical therapy and assessment services shall be licensed as
physical therapists and physical therapist assistants in accordance with
Chapter 486, F.S. Physical therapists may provide this service as
independent vendors or as an employee of an agency. They may also
employ and bill for the services of a licensed physical therapy assistant.
The licensed physical therapy assistant is not qualified to perform physical
therapy assessments. Assessments can only be performed by a licensed
Physical therapy assistants must be supervised by a physical therapist in
accordance with the requirements of their professional licenses.
The provider is responsible for all training requirements outlined in the Core
Note: Refer to the Core Assurances in Appendix A for the provider training