Under what conditions are outpatient therapy services covered?

Outpatient therapy services are covered when a plan of care is established and reviewed while the patient is under a physician's care. This condition ensures that therapy services are medically necessary and integrated into the overall treatment strategy for the patient's condition. The physician's involvement is essential to confirm that the therapy aligns with the patient's diagnosis and treatment goals, which is a critical component for coverage under insurance guidelines.

The need for an established plan of care and ongoing reviews ensures that there is a structured approach to the patient's rehabilitation process, allowing for adjustments to be made based on the patient's progress or changing needs. This structured methodology helps support the medical necessity of the services being billed to insurance.

Therefore, robust documentation of the plan and its regular evaluation by the physician underscores the justification for the services rendered, making it a key element for coverage.