Article Detail - JE Part A
Initial Certification and Recertification Outpatient Therapy - New Exception
Effective for claims on or after January 1, 2025, when a patient is referred for physical, occupational, or speech-language pathology therapy; by a physician or other qualified nonphysician practitioner:
- Signed and dated order or referral satisfies certification requirements, provided the order is included in patient’s medical record
- Evidence that plan of care (POC) was submitted to the referring provider within 30 days of the initial evaluation
Under this new exception, once the therapist has transmitted the POC, the responsibility shifts to the referring provider to either return the signature or indicate any changes. If neither action is taken, silence is considered as consent to the therapist submitted POC.
This new rule emphasizes and trusts the therapist’s clinical judgment, requiring only documentation of the order or referral.
There is no requirement for a physician or nonphysician practitioner (NPP) order or referral for patients to obtain outpatient therapy services, to clarify in § 424.24(c)(5) that references to an order or referral should not be interpreted as requiring an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.
