This version of the policy will become effective 01/13/2020.
This policy has been updated in consideration of existing Evidence of Coverage revisions for Maintenance Therapy.
Traditional outpatient therapy services are moderately intensive multi-disciplinary services performed in an outpatient facility. The individual may receive all three rehabilitative therapy disciplines, but will typically receive one hour of each rehabilitative therapy three days per week.
Subject to the terms and conditions of the applicable Evidence of Coverage, day rehabilitation is covered under the medical benefits of the Company’s Medicare Advantage products when the medical necessity criteria listed in this medical policy are met. However, services that are identified in this policy as not medically necessary or not covered by Medicare are not eligible for coverage or reimbursement by the Company.