Today, April 30th, CMS issued another round of regulatory waivers and rule changes….including 2 key pieces impacting the therapy world. These rule changes focus on expanding access to the healthcare system both directly and through telehealth.

First, here are the links to the source documents:

CMS Press Release Summary of Changes

CMS Blanket Waiver Update for COVID-19 Emergency 

CMS FAQ for COVID-19 and Fee For Service Billing (Part B)

The 2 highlights found in the documents that pertain to therapy practice are:

  1. Telehealth
  2. Skilled Maintenance Therapy for Part B


Prior to today, therapists were not considered approved providers of telehealth services for Medicare Part B. CMS has temporarily updated the eligible practitioners to include physical, occupational and speech therapists in the private practice setting.

Under the heading “Further Expand Telehealth in Medicare” CMS states:

Eligible Practitioners. Pursuant to authority granted under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) that broadens the waiver authority under section 1135 of the Social Security Act, the Secretary has authorized additional telehealth waivers. CMS is waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2) which specify the types of practitioners that may bill for their services when furnished as Medicare telehealth services from the distant site. The waiver of these requirements expands the types of health care professionals that can furnish distant site telehealth services to include all those that are eligible to bill Medicare for their professional services. This allows health care professionals who were previously ineligible to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others, to receive payment for Medicare telehealth services.

The existing Medicare regulations for telehealth pertain to the outpatient private practice setting, where therapists bill Medicare Part B directly (excludes institutions such as SNF). This expansion to now allow therapists to provide and bill for telehealth is likely only pertaining to the same practice setting, though it is a huge 1st step for the therapy profession.

We will need to see if CMS clarifies whether or not therapists in alternate settings such as SNF, who bill under the facility provider number on a UB-04 claim form, will be included in the regulation updates. As for now, therapists in private practice are very happy, and we are happy for them and the patients they serve!

For detailed background on the telehealth, e-visit and telephone service changes, and how they pertain to therapists – click HERE.

Skilled Maintenance Under Part B

Under the heading “Healthcare Workforce Augmentation” CMS states the following: “To bolster the U.S. healthcare workforce amid the pandemic, CMS continues to remove barriers for hiring and retaining physicians, nurses, and other healthcare professionals to keep staffing levels high at hospitals, health clinics, and other facilities. CMS also is cutting red tape so that health professionals can concentrate on the highest-level work they’re licensed for.”

A specific bullet point in this section is as follows:

CMS is allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings. This frees up physical and occupational therapists to perform other important services and improve beneficiary access.

Prior to today, skilled maintenance therapy services billed using the Physician Fee Schedule (Part B) in all settings (SNF, Outpatient, etc) were required to be provided by a physical or occupational therapist. Assistants were not allowed to furnish these programs under Part B, even though they are able for Part A. This rule update makes perfect sense for the current situation, and will hopefully be a rule that stays on the books when the waivers expire.


These 2 regulation changes are a positive for both the seniors we care for and the profession as a whole. We can look for clarification from CMS in the days to come and will hopefully shake out the details on one of the provider calls soon.

If you need more info about the COVID-19 waiver changes to date for Medicare Part A and Part B in the SNF setting, visit our COVID-19 Resource Page or read our in depth article outlining the Part A and Part B changes for the SNF setting as a result of the waivers.

If you have any questions about any of the above information or need additional information, use our Just Ask Q&A Forum and one of our team members will respond to you directly to assist.

For all you continue to do to serve our seniors, thank you.

In Your Corner,

Dolores Montero, PT, DPT, RAC-CT, RAC-CTA

SNF Rehab and MDS Compliance Team

*Addition on 5/5/20: CMS provided confirmation in a Office Hour Call that Telehealth for therapy services applied to Private Practice only. SNF and other institutional settings are excluded. CMS will post the transcripts to this call on their Podcast and Transcript page HERE.

**On 5/6/20, APTA also confirmed this information HERE

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