Ask CAHSAH

Question: Are Physical Therapist Assistants who are new graduates allowed to see Medicare patients in the home health setting?

Answer: Yes but certain key requirements must be met:

1. State Licensure or Certification

• The PTA must be licensed, certified or registered according to state laws
• The PTA must typically pass the National Physical Therapy Exam (NPTE) before they can practice

2. Supervision Requirements for Medicare

• PTAs  treating Medicare Part B patients must be under the supervision of a licensed Physical Therapist (PT), Direct supervision means the PT is on-site and immediately available
• For Medicare Part A, the rules vary slightly but still require oversight by a PT

3. Billing Under Medicare

• PTAs cannot bill Medicare independently
• Services provided by a PTA are billed under the supervising PTs NPI, not the PTA’s
• Reimbursement is 85% of the Medicare fee schedule when the service is provided in whole or in part by a PTA

4. No Graduate PTA Provision

• Medicare does not recognize a Graduate PTA like some states may
• A provider must be licensed to participate in Medicare billing and treatment