Getting PT Services for Your Patients

By Jo Reeder, PT, MCSP

Physical therapy (PT) can be a valuable resource for the dialysis unit team as it treats patients’ physical decline. A variety of payers will cover PT services, but certain procedures must be followed.

How Physical Therapy Services Are Prescribed

In most states, a physician must make the actual PT referral. However, any health care professional (i.e., RN, RD, SW, PCT) can recommend physical therapy to a patient’s doctor. PT referrals are for functional decline, decreased muscle strength, decreased joint range, gait problems, new onset of stroke or head injury, and/or a wound affecting function.

After the referral and a patient evaluation, the physical therapist develops a written plan of therapy. This plan includes the diagnosis, treatment plan, goals of therapy, and frequency and duration of the intervention. The physician reviews and approves the plan of care; there is an expectation that the condition will improve in a reasonable length of time.

Most insurance providers allow a set number of visits, and this varies from company to company. If your patient has commercial insurance, check with the patient’s insurance carrier about coverage for physical therapy. There are also limitations on Medicare coverage of physical therapy. If your patient has Medicare, a physical therapy provider or the Center for Medicare and Medicaid Services (CMS) regional office can give you information about Medicare coverage for physical therapy services. You can find the phone number for your CMS (formerly HCFA) regional office.

The American Physical Therapy Association (APTA) has posted information about reimbursement for physical therapy services. You can also find a chart of state regulations pertaining to direct access to physical therapy evaluation, examination, and intervention.

Where Physical Therapy Services Are Provided

Dialysis unit staff can help patients access PT services in different settings. Patients can go to a free-standing, outpatient physical therapy clinic; go to an inpatient rehabilitation center; receive home health physical therapy if they qualify as “homebound”; or they can go to the physical therapy department of a hospital.

At University of Virginia Health Systems, for example, physical therapy is provided within the dialysis center so the patients can get their physical treatment before, during, or after dialysis. This on-site PT has been very effective for both patients and staff. It is easier to facilitate on-site physical therapy in a hospital-based unit, but with a little extra planning it can be achieved in a free-standing unit.

Physical therapy intervention can break the spiral of debilitation and decompensation frequently observed in the ESRD population. In addition, a more physically active, higher functioning end-stage renal disease population may have significantly better long-term survival rates.

For information on physical therapy in practice, see the tip entitled What Physical Therapy Can Do: One Patient’s Story.

Name: Jo Reeder, PT, MCSP
Title: Physical Therapist
Organization: Renal Services, UVA Health Systems
Charlottesville, VA
Date: November 2001