Ask a PT: Access to Home Health Physical Therapy

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Question: I am having a major knee replacement surgery, and I am worried that I will not be able to attend out-patient physical therapy after spending just one overnight in the hospital after surgery.  My doctor has told me my insurance won’t cover physical therapy in my home if I am unable to physically get out of the house for my out-patient appointment.  What can I do?

Answer: For many patients who are not physically able to leave their home due to extreme pain or functional disability from a recent major medical procedure (knee, hip, ankle, or shoulder replacement or spine fusion), home health physical therapy is the perfect option.  If a patient is considered “homebound,” meaning you are unable to travel outside the home for anything except for your physician visit (not due to a transportation issue), you are eligible for your insurance (including Medicare and Medicaid) to pay for a physical therapist to travel directly to your home.  Many doctors have changed their recommendations for home physical therapy due to the impact of a Medicare case-mix classification model called the Patient-Driven Groupings Model that took effect on January 1, 2020.  The model simply changed from relying on therapy service thresholds to relying more on clinical characteristics of patients and a change from 60-day to 30-day episodes of home health care.  Medicare states that the intended impact of this act was to reduce the over-utilization of home physical therapy, not to block Medicare beneficiaries from obtaining this home healthcare benefit entirely.  Kindly inform your physician that if you meet the “homebound” requirement based on your particular clinical symptoms and functional limitations, getting physical therapy at home is a covered and encouraged Medicare benefit to help you successfully recover as you bridge from acute to out-patient post-operative care. 

If you have further questions or concerns on this matter, feel free to contact MotionWorks Physical Therapy owner, Dr. Jill Murphy, at jill@motionworkspt.com or 920-215-2050 to answer any questions and provide further clarification.  While MotionWorks does not provide home physical therapy services, we strongly advocate for all of our patients and members of our Fox Valley community to get timely, effective physical therapy when and where you need it!