Acute inpatient therapy services are intensive (at least three hours a day, five to seven days per week), consisting of at least two rehabilitative therapies, other associated medical services (e.g., case management), with 24 hours of medical and nursing supervision. Services are generally performed in a rehabilitation unit within a hospital or in a free-standing rehabilitation hospital.
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.