HI 00401.300 Physical Therapists in Independent Practice
Social Security Act—Sec. 1861(p)
A. Qualified physical therapist defined
A qualified physical therapist for program payment purposes is an individual who is licensed as a physical therapist by the State in which he is practicing and meets one of the following requirements:
Has graduated from a physical therapy curriculum approved by the American Physical Therapy Association (APTA), or by the Council on Medical Education and Hospitals of the American Medical Association, or jointly by the Council on Medical Education of the American Medical Association and the American Physical Therapy Association; or
Prior to January 1, 1966, was admitted to membership by the APTA, or was admitted to registration by the American Registry of Physical Therapists, or has graduated from a physical therapy curriculum in a 4-year college or university approved by a State department of education; or
Has 2 years of appropriate experience as a physical therapist and has achieved a satisfactory grade on proficiency examination approved by the Secretary except that such determinations of proficiency will not apply with respect to persons initially licensed by a State as a physical therapist after December 31, 1977, or seeking qualification as a physical therapist after that date; or
Was licensed or registered prior to January 1, 1966, and prior to January 1, 1970, had 15 years of full-time experience in the treatment of illness or injury through the practice of physical therapy in which services were rendered under the order and direction of attending and referring physicians; or
If trained outside the United States, was graduated since 1928 from a physical therapy curriculum approved in the country in which the curriculum was located and in which there is a member organization of the World Confederation for Physical Therapy, meets the requirements for membership in a member organization of the World Confederation for Physical Therapy, has 1 year of experience under the supervision of an active member of the APTA, and has successfully completed a qualifying examination as prescribed by the American Physical Therapy Association.
The Medicare RO informs the carriers of those physical therapists who are qualified and hold the required Medicare credentials.
B. Independent practice defined
A qualified physical therapist is considered to be in independent practice when he renders services on his own responsibility and free of the administrative and professional control of an employer such as a physician, institution, agency, etc., the persons he treats are his own patients; and he has the right to collect fees for the services he renders. While the therapist need not be in full-time private practice he must be engaged in private practice on a regular basis, i.e., he is recognized as a private practitioner and for that purpose he maintains at his own expense an office or office space and the necessary equipment to provide an adequate program of physical therapy.
An office (or office space) in a hospital, SNF, or on the premises of any clinic or agency participating as a provider of outpatient physical therapy services utilized by a physical therapist in furnishing such services as an employee of or under arrangements with the provider, may not be considered the physical therapist's office for purposes of this section. The expressed purpose of this limited benefit is to make physical therapy more readily available to the beneficiary in cases where the therapist's office might be more accessible than a provider's facility.
A physical therapist will be considered engaged in private practice on a regular basis when he maintains office hours of such frequency and duration that the patients he undertakes to treat can receive services as medically indicated.