Performing Maintenance Therapy for Medicare Patients

Please note that this article contains information that is only relevant to America clinics.


Among the many types of treatments performed for Medicare patients is skilled maintenance therapy. But what exactly is maintenance therapy? By definition, as long as the therapy is improving a function, minimizing the loss of a function, or decreasing the risk of a future injury, it can be considered maintenance therapy–and your clinic is eligible to get paid for performing those services. In this article, we’re going to discuss why your clinic should be offering maintenance therapy to Medicare patients.


For several years, there was much debate about whether or not maintenance therapy was eligible for payment. The matter eventually went to a federal court, and it was ruled that maintenance therapy ought to be paid for by Medicare. But even after the ruling, there was still considerable confusion about how to go about submitting those types of claims.


On February 1, 2017, the court ruled that the CMS must take measures to ensure that this new process is widely understood by therapists throughout the country. Among these measures are: a webpage explaining the Jimmo settlement (linked below), a FAQ, and a new national call explaining the correct maintenance coverage policy.


In accordance with the Jimmo Settlement, “Skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.”


So, if you’re ever wondering if your maintenance therapy is eligible for payment under Medciare Part B services, you’ll be glad to know that it is!

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