The physical therapy must be furnished under a plan established and periodically reviewed
by the physician caring for the patient. The plan must be established (i.e., reduced
to writing either by the physician who makes the plan available to the physical therapist
or by the therapist when the therapist makes a written record of the physician's oral
orders) before treatment is begun. The plan must be promptly signed by the physician
and incorporated into the physical therapist's permanent record for the patient.
The plan must relate the type, amount, frequency, and duration of the physical therapy
services that are to be furnished the patient and indicate the diagnosis and anticipated
goals. Any changes should be made in writing and signed by the physician or by the
physical therapist pursuant to the attending physician's oral orders. The services
specified in the plan may not be altered in type, amount, frequency, or duration by
the therapist (except in the case of an adverse reaction to a specific treatment).
The plan must be reviewed by the physician, in consultation with the physical therapist
at such intervals as the severity of the patient's condition requires, but at least
every 30 days. Each review of the plan should contain the initials of the physician
and the date of review. The patient's plan normally need not be forwarded to the carrier
for review but will be retained in the physical therapist's file. The physical therapist
must certify on the billing form that the plan is on file and was in effect at the
time the services were rendered.
The plan of treatment and the physical therapist's clinical records concerning the
beneficiary will be retained by the therapist but must be available to the carrier
or its professional consultants when the carrier deems review of these documents necessary
to the performance of its claims processing obligations.