Q&A: Therapeutic Services

March 29, 2016
Medicare Web

Q: What are therapeutic services?

A: Therapeutic services include most non-diagnostic services furnished to patients in clinics, emergency departments, and urgent care centers to treat, rather than diagnose, the patient’s condition. These include patient examinations and assessments, surgical services, and minor procedures such as wound care, medication management, and infusions (42 CFR §410.27[a], 2011; Medicare Benefit Policy Manual, Chapter 6, §20.5.1, 2014). Diagnostic services such as x-rays, electroencephalograms, electrocardiograms, and laboratory tests have separate coverage requirements and will be discussed below.

Note that we are referring here to the facility component of the therapeutic services furnished to Medicare beneficiaries, which is furnished by the hospital (including provider-based departments). We are not including in this discussion the professional services furnished to the patient by physicians and other nonphysician practitioners who bill separately for these services. Payment for facility services is separate and distinct from payment for professional services, as discussed in detail in Chapter 6. Therefore, do not make the mistake of confusing the facility component of therapeutic services with the professional component of these services when reviewing the Medicare “incident to” rules discussed below.

For more information, see the book Provider-Based Entities: A Guide to Regulatory and Billing Compliance.

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