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  • Tri-Alliance Issues Joint Guidelines for Therapy Cotreatment Under Medicare

    APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA) have issued guidelines to help therapists recognize appropriate opportunities for cotreatment. Cotreatment may be appropriate when practitioners from different professional disciplines can effectively address their treatment goals while the patient is engaged in a single therapy session. For example, a patient may address cognitive goals for sequencing as part of a speech-language pathology treatment session while the physical therapist (PT) is training the patient to use a wheelchair. Or, a patient may address activities of daily living goals for increasing independence as part of an occupational therapist treatment session while the PT addresses balance retraining with the patient to increase independence with mobility. 

    The guidelines contain information on proper documentation for cotreatment sessions and 3 clinical examples of 2 disciplines providing interventions during 1 treatment session. APTA has provided the document to the Centers for Medicare and Medicaid Services, as the agency had requested guidance on cotreatment therapy sessions from the 3 associations.  

    APTA will continue to work with CMS to develop additional resources for therapists, specifically in the skilled nursing facility setting, to ensure a thorough understanding of therapy coverage requirements.


    • It would be nice if the Tri-alliance could provide examples of group co-treatment as indicated in the MDS 3.0 RAI Manual. This was added to the January update effective April 1st. I cannot imagine a situation where a group setting would be appropriate for co-treatment, but maybe that's just me.

      Posted by Pauline M Franko on 2/17/2012 3:33 PM

    • Do you have also the guidelines on how to bill? If a patient is being co-treated with PT and OT for one hour. Will we charge 30 minutes PT and 30 minutes OT? or one hour per discipline?

      Posted by Martha Houghton on 2/20/2012 10:17 AM

    • i am also curious about the billing. assuming we are talking direct one on one intervention, in a one hour session, is it 30 PT and 30 OT or one hour per discipline. I am also curious if the same guidelines (billing and application) apply to outpatient Part B care?

      Posted by joe wood on 3/8/2012 5:29 AM

    • i am trying to find out the answer as well. If OT has 75 minutes with a patient and PT has 75 minutes as well and they cotreat, do they split the 75 minutes or both charge 75 minutes each discipline and do they bill it as 1 on 1 treatment

      Posted by farside on 3/27/2012 9:23 PM

    • Please address billiing for co-treatments. If a resident is co-treated by PT and OT for a 1/2 hour session. Does each discipline bill for 1/2 hour or are the minutes split to 15 minutes each?

      Posted by Carol on 5/21/2012 9:45 AM

    • Has the billing issues above been addressed somewhere with guidelines? We are having this discussion in our clinic.

      Posted by Janice Glasnovich -> ?HRb@ on 11/20/2013 11:37 AM

    • I cannot tell you how hopeful I am for the profession of Physical Therapy after reading this news. The Evidence-Based pendulum has swung so far that I have heard therapists say they can't make an independent decision without a research study to back it up. I have actually shuddered to think about our profession if we allow this to happen. Glad to see Clinical Expertise and Judgement back in the equation.

      Posted by Sara Meeks PT, MS, GCS, KYT on 10/17/2014 8:17 PM

    • Have the billing issues been addressed w/ guidelines? Need IRF guidelines. If PT and OT cotreat for 60 min does the OT 60 min and the PT 60 min each contribute to the 3 hr rule? Does each discipline bill 60 min.?

      Posted by Susan Foster, PT on 2/11/2015 3:12 PM

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