Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1806 (March 30, 2024).

55 Pa. Code § 1249.56. Payment conditions for physical therapy, occupational therapy, speech pathology and audiology services.

§ 1249.56. Payment conditions for physical therapy, occupational therapy, speech pathology and audiology services.

 Home health agencies are reimbursed for physical therapy, occupational therapy, speech therapy and audiology services if the following conditions are met:

   (1)  The service is prescribed by the recipient’s attending physician.

   (2)  The service is performed by a physical therapist, occupational therapist, speech therapist or audiologist currently licensed to practice in this Commonwealth.

   (3)  The service is reasonable and necessary for the treatment of the recipient’s illness or injury. To be considered reasonable and necessary, the services furnished shall be:

     (i)   Consistent with the recipient’s particular medical needs as ordered by the recipient’s attending physician.

     (ii)   Consistent with accepted standards of medical practice.

Authority

   The provisions of this §  1249.56 amended under sections 403(a) and (b), 443.2(2) and 509 of the Public Welfare Code (62 P. S. § §  403(a) and (b), 443.2(2) and 509).

Source

   The provisions of this §  1249.56 adopted December 6, 1980, effective December 1, 1980, 10 Pa.B. 4618; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended August 12, 1988, effective September 1, 1988, 18 Pa.B. 3571; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418. Immediately preceding text appears at serial pages (117532) to (117533).

Cross References

   This section cited in 55 Pa. Code §  1249.51 (relating to general payment policy).



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