2025 Policy and Procedure Manual for Medicare Part B OFFICE and AT HOME Service

This 22 page manual establishes comprehensive policies and procedures for physical therapists (PT), occupational therapists (OT), and speech-language pathologists (SLP) providing Medicare Part B home health services. It ensures compliance with Centers for Medicare & Medicaid Services (CMS) regulations, maintains quality patient care standards, and provides operational guidance for approved Medicare Part B providers. This manual applies to all therapy personnel providing home-based services under Medicare Part B including:

• Licensed Physical Therapists and Physical Therapist Assistants
• Licensed Occupational Therapists and Occupational Therapy Assistants
• Licensed Speech-Language Pathologists and Speech-Language Pathology Assistants
• Administrative and support staff involved in Medicare Part B operations

INTRODUCTION AND SCOPE
Purpose   1.2 Scope   1.3 Regulatory Authority

1. MEDICARE PART B COMPLIANCE REQUIREMENTS
   2.1 Provider Enrollment and Credentialing  2.1.1 Enrollment Requirements
   2.1.2 Ongoing Compliance Monitoring  2.2 Patient Eligibility and Coverage
   2.2.1 Medicare Part B Coverage Criteria 2.2.2 Setting-Specific Requirements
   3.OFFICE-BASED FACILITY REQUIREMENTS
   3.1 Physical Facility Standards  3.1.1 Space Requirements
   3.1.2 Accessibility and Safety  3.2 Equipment and Supplies
   3.2.1 Standard Equipment Requirements 3.2.2 Infection Control and Sanitization
   3.3 Office-Based Operational Requirements 3.3.1 Staffing and Supervision
   3.3.2 Appointment Scheduling and Patient Flow 3.3.3 HIPAA Compliance Requirements
   3.3.4 Required Signage and Postings 3.4 Emergency Preparedness Plan
   3.4.1 Emergency Policies and Procedures 3.4.2 Business Continuity Plan Template Template
   4. DOCUMENTATION STANDARDS
   4.1 Initial Evaluation Documentation
   4.1.1 Required Elements (All Settings)
   4.1.2 Setting-Specific Documentation
   5.BILLING AND CODING PROCEDURES
   5.1 CPT Coding Guidelines
   5.1.1 Physical Therapy Evaluation Codes
   5.1.2 Occupational Therapy Evaluation Codes
   5.1.3 Speech-Language Pathology Evaluation Codes
   5.1.4 Place of Service Codes
   5.2 Setting-Specific Billing Considerations
   5.2.1 Home-Based Services
   5.2.2 Office-Based Services
   5.3 Advance Beneficiary Notice (ABN) Requirements
   5.3.1 When ABN is REQUIRED
   5.3.2 When ABN is NOT Required
   5.3.3 ABN Documentation Requirements
   5.3.4 ABN Decision Tree
   5.3.5 Common ABN Scenarios for Therapy Services
   5.3.6 ABN Compliance Tips
   6.QUALITY ASSURANCE AND COMPLIANCE
   6.1 Quality Improvement Program
   6.1.1 Performance Monitoring
   6.1.2 Setting-Specific Quality Measures
   6.1.3 Incident Reporting Procedures
   7. DETAILED POLICIES AND FORMS
   7.1 Incident Report Form
   7.2 Confidentiality and Release of Information Policy
   7.2.1 HIV-Related Information Policy
   7.2.2 Detailed HIPAA Privacy Policies
   8. COMPLIANCE MONITORING AND AUDITING
   8.1 Internal Audit Program
   8.2 Setting-Specific Audit Requirements
   8.2.1 Home-Based Services Audits
   8.2.2 Office-Based Services Audits
   9. ACKNOWLEDGMENT AND COMPLIANCE CERTIFICATION 

Twenty two pages, downloadable, editable and attorney reviewed, this policy and procedure manual covers Medicare Part B patients who are treated either in the OFFICE or the HOME and should be kept in case of a Medicare audit.