ALEXANDRIA, VA, August 10, 2009 — The American Physical Therapy
Association (APTA) is calling on the Centers for Medicare and Medicaid
Services (CMS) and Congress to act to prevent unqualified personnel from
providing physical therapy services following the release of a federal
report on physician "incident to" services (services
that are billed by physicians but are performed by nonphysicians) billed
in 2007 under the Medicare program.
The report, released by the Office of Inspector General (OIG) of the
US Department of Health and Human Services, found that when Medicare
allowed physicians more than 24 hours of services in a day, half of the
services were not performed personally by a physician.1 It
also found that unqualified nonphysicians performed 21% of the services
that physicians did not perform personally. Additionally, 49% of
rehabilitation therapy services (including primarily therapeutic
exercise, massage therapy, ultrasound therapy, therapeutic activities,
and electrical stimulation) performed by nonphysicians were furnished by
staff not trained as therapists and who the OlG found to be
Medicare rules require that physical therapy services provided
"incident to" the professional services of a physician be furnished by a
graduate of a professional physical therapist program, or a nurse
practitioner, clinical nurse specialist, or physician assistant if
allowed by state law. Medicare is authorized to only pay for services
provided by individuals trained specifically in physical therapy.
"APTA is alarmed by these findings," said APTA President
R. Scott Ward, PT, PhD. "To ensure high quality care, physical therapy
services should be furnished by licensed physical therapists and
physical therapist assistants under the direction and supervision of a
physical therapist. APTA urges Congress to take action to remove
physical therapy as an 'incident to' service in physician offices and to
tighten Stark II referral-for-profit regulations to eliminate financial
incentives that contribute to high physician billing of physical therapy
The sample for the report included only those physicians
who billed for more than 24 hours of services in a day. "However, we
have no reason to believe that the issues identified in this review are
unique to these physicians," said the OIG.
Physical therapists are highly-educated, licensed health care
professionals who can help patients reduce pain and improve or restore
mobility — in many cases without expensive surgery or the side
effects of prescription medications. APTA represents more than 72,000
physical therapists, physical therapist assistants, and students of
physical therapy nationwide. Its purpose is to improve the health and
quality of life of individuals through the advancement of physical
therapist practice, education, and research. In most states, patients
can make an appointment directly with a physical therapist, without a
physician referral. Learn more about conditions physical therapists can
treat and find a physical therapist in your area at www.moveforwardpt.com.
1. US Department of Health and Human Services.
Prevalence and qualifications of nonphysicians who perform non physician
Published August 2009. Accessed August 10, 2009.