How to discharge a therapy patient well

For OT, PT and SLP practices seeing children, adults or both: discharge when the clinician’s reassessment shows skilled care is no longer needed, when the patient or family decides to stop, or when care moves elsewhere. Then write the discharge note, explain the decision and next steps, hand off a home program and update the referring practitioner.

What does a good discharge from outpatient therapy include?

Six parts: a clinical decision with its reason, a discharge note, a conversation with the patient or family, a home program or other next step, a summary to the referring practitioner, and an administrative close. The decision belongs to the treating clinician; each other part needs a named owner.

Plan the end at the start. ASHA’s practice portal lists discharge criteria among the parts of a speech-language plan of care, beside measurable goals and a home exercise program if applicable.⁠¹⁰ Writing discharge criteria into a PT or OT plan does the same work: the family hears at the first visit what result ends the episode.

When should an OT, PT or SLP discharge a patient from therapy?

When the clinician’s reassessment shows the goals are met, skilled care is no longer needed or the patient is not benefiting, or when the patient or family chooses to stop. The decision comes from the record, not from the schedule, a revenue target or a payer’s letter:

• Goals met. Medicare’s manual notes that patients may be discharged before a plan’s estimated end because they improve faster than estimated or have progressed to an independent home program.⁠¹¹
• No skilled need. Medicare does not count a service as skilled therapy when the patient can do it alone or an unskilled person can furnish it safely and effectively, even if a therapist delivers it.⁠²
• No expected benefit. For SLPs, ASHA’s code says certificate holders provide services only when benefit can reasonably be expected.⁠⁵
• Patient or family choice. Record the decision, the day and what the clinician recommended.
• The practice cannot provide what is needed. That is a transfer, not a discharge.

There is no standard number of visits. Medicare’s manual says that a service being typically billed is not evidence that it is typically appropriate, and that some episodes should be shorter than typical when a patient reaches goals sooner.⁠¹ Set the end from the patient’s goals and measures, never from an average or an internal visit target.

Is a plateau a reason to discharge a Medicare therapy patient?

Not by itself. Medicare’s manual states that coverage does not turn on the beneficiary’s potential for improvement but on the need for skilled care, and that skilled therapy may be needed to improve a condition, to maintain it, or to prevent or slow deterioration.⁠² CMS’s Jimmo page says the 2013 settlement clarified that the outpatient therapy benefit covers skilled therapy needed to maintain function or to prevent or slow decline, provided all other coverage criteria are met.⁠¹²

CMS’s Jimmo FAQs set out the decision. For a patient who had been expected to improve but is no longer improving, a determination must be made whether skilled care is needed to maintain the current condition or prevent or slow further deterioration; if it is, a plan of care with new maintenance goals must be developed, and if it is not, the services are not covered.⁠³ Lack of restoration potential cannot by itself be the basis for denying coverage, and Medicare Advantage plans must apply the same standard.⁠³ CMS’s fact sheet adds that no “Improvement Standard” applies to maintenance claims in which skilled care is required.⁠¹³

Document a plateau either way: the manual recommends recording the reasons for lack of progress, and the justification for continuing if treatment continues.⁠¹ CMS notes that the manual treats phrases such as “patient tolerated treatment well” and “patient remains stable” as too vague to establish coverage.⁠³ Jimmo is Medicare’s standard; for a Medicaid or commercial plan, read its own maintenance-therapy policy.

Discharge, transfer, pause or payer-driven end: which one applies?

Name the situation first, because each one needs different words and a different record:

A pause under Medicare runs against the certification: a physician or NPP certifies a plan for up to 90 calendar days, and treatment beyond the certified duration requires a recertified plan.⁠¹¹ When a hold outlasts the plan, the return starts with recertification or a new plan of care.

When a patient stops coming, contractors do not require the clinician’s participation in treatment for the incomplete reporting period, and the discharge report can rest on the treatment notes.⁠¹ Send the patient a short letter too, with the home program and the way back.

What must a Medicare discharge note for therapy contain?

Under Medicare Part B, the discharge note (or discharge summary) is required for each episode of outpatient treatment, and it is a progress report written by a clinician, covering the period from the last progress report to the date of discharge.⁠¹ The manual sets its content in its own words:

• “The discharge note shall include all treatment provided since the last progress report and indicate that the therapist reviewed the notes and agrees to the discharge.”⁠¹
• For a discharge the plan did not anticipate, “the clinician may base any judgments required to write the report on the treatment notes and verbal reports of the assistant or qualified personnel.”⁠¹
• For a discharge anticipated within 3 treatment days of the progress report, the clinician may set objective goals that, once met, authorize the assistant or qualified personnel to discharge the patient.⁠¹
• At the clinician’s discretion, the note “may summarize the entire episode of treatment, or justify services that may have extended beyond those usually expected for the patient’s condition.”⁠¹

The manual tells clinicians to consider the discharge note “the last opportunity to justify the medical necessity of the entire treatment episode in case the record is reviewed.”⁠¹ A re-evaluation before a planned discharge is optional: one may be appropriate to determine whether goals have been met, or for the use of the physician or the setting where treatment continues, but it is not a routine, recurring service.⁠¹

Which other Medicare documentation rules shape the discharge?

Three more rules frame the record a discharge note closes. A progress report is due at least once every 10 treatment days; recertification is required at least every 90 days and is signed by the physician, NP, CNS or PA who reviews the plan; and the referring or supervising physician or NPP does not have to sign progress reports written by the PT, OT or SLP.⁠^1,14

The current regulation has one exception for the initial certification: when a PT, OT or SLP establishes the plan, a written order or referral from the patient’s physician, NP, PA or CNS is in the record, and the therapist has documented delivering the plan to that practitioner within 30 days of the initial evaluation, the certification does not need that practitioner’s signature, and the paragraph creates no requirement for an order or referral.⁠¹⁴ Recertification keeps its signature requirement.⁠¹⁴

Medicare counts an episode per discipline, from the first day under the clinician’s care for the condition until the last date of service for that discipline in that setting, so a patient seen for both PT and speech therapy has two episodes and two discharge notes.⁠¹ The manual calls its documentation rules minimal expectations and says state or local law, the profession’s guidelines, the practice or the facility may be more stringent.⁠¹

What do APTA, ASHA and AOTA say a discharge summary covers?

APTA and ASHA list contents and AOTA’s public page states the purpose, each for its own discipline:

• Physical therapy. APTA’s documentation guideline requires documentation at the end of the episode summarizing progression toward goals and discharge plans: current physical and functional status, the degree of goals achieved and reasons for goals not achieved, and a plan for continuing care such as a home program, referrals, recommendations for follow-up PT, family and caregiver training, and equipment provided.⁠¹⁵
• Speech-language pathology. ASHA’s practice portal says a discharge summary typically includes dates of treatment, goals and progress, the treatment provided, objective measures such as pre- and posttreatment evaluation results, functional status, patient and caregiver education, the reason for discharge, and recommendations for follow-up.⁠¹⁰
• Occupational therapy. AOTA’s documentation page describes documentation that reflects the services provided, shows the practitioner’s clinical reasoning, and gives enough information for safe and effective services.⁠¹⁶ An OT discharge note for a Medicare patient must also meet the manual’s rule above.

How do you tell a patient or family that therapy is ending?

In person, before the last visit, and then in writing. A discharge planned from the evaluation gives the patient or family time to ask questions, practice the home program and arrange what comes next. Cover five points:

1. Why care is ending, tied to the goals the patient or family agreed to.
2. What changed, without promising that gains last or that difficulties do not return.
3. What to keep doing, and who carries it out.
4. The specific signs that should prompt a call or a return.
5. How to come back: whether a new referral, evaluation or authorization would be needed, and whom to call.

If the patient or family disagrees, the clinician hears it out and records it, with what was offered: continued care under a new plan if there is a skilled need, a second opinion, or another provider.

Who should receive the discharge letter for a child or an adult?

For a child, usually the parent; for an adult, the adult. HHS explains that in most cases a parent, guardian or other person acting in loco parentis is a minor child’s personal representative, because the parent usually has authority over the child’s health care decisions, and that the Privacy Rule defers to state or other law that expressly addresses a parent’s access to a minor’s information.⁠¹⁷ Talk with the child or teenager too, in words they can use.

For an adult, write to the adult. A relative who drove the patient to appointments is not, for that reason, the recipient of clinical letters; follow the patient’s recorded preferences and any legal authority.⁠¹⁷ The pediatric-to-adult transition guide covers the same question for young adults leaving a pediatric service.

What do the PT, SLP and OT ethics codes say about ending care?

The PT and SLP codes each call for reasonable notice and information about other sources of care when the clinician ends or can no longer provide services, in their own words, and AOTA’s 2025 code has its own Standards of Conduct. Quote your own discipline’s clause, never another’s:

• Physical therapy. APTA’s Code of Ethics for the Physical Therapy Profession, dated January 1, 2026, Standard of Conduct 4.4: “Physical therapists shall provide reasonable notice and information about alternative sources for obtaining care if the physical therapist terminates the provider relationship while the patient or client continues to need physical therapist services.”⁠⁴
• Speech-language pathology. ASHA’s Code of Ethics, effective March 1, 2023, Principle I, Rule T: “Individuals shall give reasonable notice to ensure continuity of care and shall provide information about alternatives for care in the event that they can no longer provide professional services.”⁠⁵ ASHA members who provide clinical services must hold the Certificate of Clinical Competence and abide by the code.⁠⁵
• Occupational therapy. AOTA’s ethics page links the AOTA 2025 Occupational Therapy Code of Ethics, published in the American Journal of Occupational Therapy, and lists an ethics advisory opinion titled “Client Abandonment” among its member resources; AOTA’s infographic says the code’s Standards of Conduct set out its specific, enforceable behaviors.⁠¹⁸ OTs should read those Standards of Conduct for the occupational therapy wording on ending and transitioning services.

A code binds its members, and a state can hold licensees to more: APTA’s introduction to the code says regulators and others may rely on it in assessing the conduct of PTs and PTAs.⁠⁴ Check your state practice act and board rules for any notice or records duty when care ends.

What happens to patients when their therapist leaves the practice?

They remain the practice’s patients, so handle the departure as a set of transfers. Review each affected patient with a remaining clinician of the same discipline, continue care inside the practice where someone has the skills and the time, and where nobody does, give the notice and information about other sources of care that the PT and SLP codes describe.⁠^4,5 Never record a patient as discharged because a clinician left, and tell families the departure date, not the reasons.

What should the referring practitioner receive at discharge?

A one-page summary: why care ended, status against the goals, the home program, any recommendation, and the changes that would warrant a new referral. For a Medicare patient, send it to the practitioner who certified the plan or whose order or referral is in the record.

HIPAA permits this without a separate authorization. HHS explains that treatment includes coordinating care among providers and referring a patient from one provider to another, and that a covered entity may disclose protected health information for the treatment activities of any health care provider; the minimum necessary standard does not apply to such disclosures.⁠¹⁹ The Privacy Rule does not require a provider to share with other providers, so the summary is the practice’s choice.⁠²⁰ The pediatrician referral guide and the adult referral guide cover the relationships behind these letters.

When does a discharge finding call for a letter to the physician?

Whenever the clinician finds something outside the therapy plan that the physician needs to act on: a fall or near fall, a new or worsening swallowing difficulty, a change in memory or communication, a skin concern, a medication question, or a safety risk at home. Give it its own paragraph or letter, say what the patient was told, and call instead when it cannot wait. APTA’s Standard 3.1 has PTs and PTAs communicate with, collaborate with or refer to other professionals when necessary, and ASHA’s code has SLPs use referral and interprofessional collaboration when appropriate.⁠^4,5

How do you hand off a home program at discharge?

In writing, after the person who carries it out has shown it back, with an end point and a contact for questions. For Medicare patients, designing and teaching the program can be covered skilled work: the manual covers a qualified therapist’s design of a maintenance program when the therapist’s specialized skill, knowledge and judgment are required, and covers instructing the patient or caregiver in it.⁠² Carrying the program out is not covered when the patient, alone or with a family member, caregiver or unskilled personnel, can do it.⁠² The manual’s own example is a patient with Parkinson’s disease who needs a therapist in the last week or weeks of a rehabilitative PT program to work out which exercises best maintain function once treatment stops.⁠²

Check understanding before the last visit. ASHA’s practice portal counts confirming patient or caregiver understanding through teach-back or return demonstration among an SLP’s skilled services.⁠¹⁰ The same check suits an OT or PT program. Write a child’s program for the adult who carries it out, and an adult’s in the language and format they asked for.

How do patients and families get therapy records after discharge?

By asking: a patient, or a parent acting as a child’s personal representative, has a HIPAA right of access. HIPAA binds a provider only if it transmits information electronically in connection with a transaction for which HHS has adopted a standard, and an entity outside the definition of a covered entity or business associate does not have to comply with the HIPAA Rules.⁠²¹ Under 45 CFR 164.524, the practice must act within 30 days of receiving a request, may take one extension of no more than 30 days by giving a written statement of the reasons and the completion date, must provide the records in the form and format requested if readily producible, and may charge only a reasonable, cost-based fee limited to listed costs.⁠⁶ HHS adds that a provider cannot deny a copy because the patient has not paid for services, and cannot charge for searching for or retrieving records, though it may charge reasonable costs of copying and mailing.⁠²⁰

Two other routes move records to the next provider:

• Provider to provider, for treatment. HHS says a provider may send copies to another provider as needed for treatment or with the patient’s permission, and that the Privacy Rule does not require it.⁠²⁰
• The patient’s direction to send a copy to someone else. A 2020 court order limited this route to copies of an electronic health record in electronic form, and HHS states that the HIPAA fee limit applies only to a person’s request for their own records, not to a request to send records to a third party.⁠²²

Put the route in the discharge letter: whom to ask, the formats the practice can produce, and the fees.

How long must a therapy practice keep a discharged patient’s records?

As long as your state requires. HHS states that the HIPAA Privacy Rule has no medical record retention requirement and that state laws generally govern how long records are kept, while HIPAA’s safeguards apply for as long as the practice keeps them, including at disposal.⁠²³ Look up your state’s rule for each discipline you practice, check whether it sets a different period for minors’ records, check each payer contract, and write the period into the records policy with the citation you relied on.

How is discharge from private therapy different from school services?

They are separate systems, so ending one does not end the other. IDEA’s Part B regulations apply to each state that receives Part B funds and bind each public agency in the state that provides special education and related services to children with disabilities.⁠²⁴ The education subpart of the Section 504 regulations applies to preschool, elementary, secondary and adult education programs that receive federal financial assistance.⁠²⁵ An IEP or a school’s 504 plan is the school’s obligation, not the private practice’s.

A child discharged from private therapy keeps whatever the IEP or 504 plan provides, and a school’s decision to end a related service does not decide whether the child needs private therapy. Ask the parent before sending anything to the school, and record their written permission. The IEP team guide covers working alongside a school, and the pediatric-to-adult transition guide covers a teenager moving to adult care.

What happens when a discharged child needs therapy again?

The family calls, and the clinician decides what the return requires. A child’s needs change as school and daily demands do, so put the signs that should prompt a call in the discharge letter, with the phone line and whether the practice keeps a waitlist. For a child on Medicaid or a commercial plan, check the plan’s rules on a new referral or authorization before the first visit back. The waitlist guide covers how a returning patient joins a queue, and the former patient check-ins guide covers checking in after discharge, including when a check-in counts as marketing under HIPAA.

What changes when discharging adult and older adult patients?

Three questions come up more often with adults: skilled maintenance instead of discharge, self-management of a long-term condition, and safety findings for the physician.

• Maintenance under Medicare. For a progressive or long-term condition, decide whether a therapist’s specialized judgment is needed for a safe and effective program. If it is, CMS’s Jimmo page confirms Medicare covers it when all other coverage criteria are met; if not, discharge with a program the patient or caregiver can carry out.⁠^2,12
• Periodic review. Medicare covers periodic re-evaluations or reassessments of a maintenance program when a therapist’s skills are needed for them, so say in the letter what would prompt one.⁠²
• Self-management and safety. Set the patient up to run the program and know when to call; a fall, a swallowing change or a home-safety risk goes to the physician in its own paragraph.

What if insurance stops paying before therapy should end?

Then coverage has ended, not the clinical need, and the record should say both. A visit limit, an expired authorization or a denied extension is the payer’s decision about payment, not a clinical discharge criterion, and the rules differ by payer:

How do you document and explain a payer-driven end to care?

Keep two entries, never one: the clinician’s recommendation (goals not yet met, the skilled need, the visits or weeks recommended), and the coverage decision (its date, reference number, stated reason and any appeal deadline). Tell the patient or family both, in that order, with the options: an appeal, self-pay after a cost estimate, a home program written as a bridge, or a pause until coverage renews. If the patient stops, the discharge note names coverage as the reason and keeps the recommendation as it stood. The insurance and fees guide covers explaining cost and coverage plainly.

Can a patient keep paying out of pocket after coverage ends?

It depends on the payer. For an uninsured patient, or one with a group or individual health plan who chooses not to have a claim submitted, a good faith estimate is due within 3 business days of a request, or within 1 business day of scheduling a service booked at least 3 business days ahead, and one estimate can cover recurring visits for up to 12 months.⁠²⁹

Original Medicare is different. Medicare’s manual states that PTs and OTs in independent practice cannot opt out of Medicare, and ASHA states that SLPs cannot opt out or enter into private pay arrangements with Medicare patients.⁠^30,31 When Medicare payment for further therapy is expected to be denied and the patient wants it anyway, the ABN is the notice that transfers potential financial liability.⁠²⁷

Can you ask for a review when a patient is discharged?

Yes, under the same rules as any review request: everyone, the same way, nothing offered in return. The FTC’s rule on consumer reviews makes it unfair or deceptive for a business to give compensation or other incentives in exchange for, or conditioned on, reviews expressing a particular sentiment, positive or negative.⁠⁹ The reviews guide covers platform rules, neutral wording and replies that disclose nothing about care.

Send it apart from the clinical letter, as a short, optional message to every discharged patient or family, whatever the outcome. On a paid DrSensory listing, families can leave reviews on the clinic’s profile and the clinic can reply publicly, under the same privacy rules as any other reply.

How should a practice track discharge outcomes and re-referrals?

Keep a discharge log, one row per episode, read it monthly, and set baselines from your own rows rather than from someone else’s benchmark:

Each month, compare planned discharges with stopped-attending endings, check how often both letters went out within your own target, and count returns and new referrals from practitioners who received summaries. Use the same measures at evaluation and discharge, as ASHA’s summary list does with pre- and posttreatment results.⁠¹⁰

Discharges change capacity too. On a paid DrSensory listing, update whether the clinic is accepting new patients, and the typical wait, as openings appear; when a clinician leaves, check that the listed specialties, ages and conditions are still ones the remaining team treats. Because a DrSensory listing covers the clinic at its address rather than each therapist, a departure changes what the clinic offers, not a therapist’s entry (DrSensory for therapists).

What belongs on a therapy discharge closing checklist?

Eight items, each with an owner, closed before the episode is marked complete:

1. Decision recorded. The clinician’s reason and the type of ending; for Medicare, the discharge note since the last progress report.⁠¹
2. Patient or family told. In person, then the letter with the home program, the signs to watch for and the way back.
3. Home program shown back. By the person who carries it out, in their language and format.
4. Referring practitioner updated. The summary sent securely, with any safety finding in its own paragraph.
5. Payment closed. Any balance explained; any payer decision, appeal deadline or estimate recorded.
6. Records route stated. Whom to ask, formats offered, and fees within the HIPAA limits.⁠⁶
7. Schedule cleared. Standing appointments canceled; any waitlist or recall entry agreed with the patient.
8. Listing checked. Accepting-new-patients status and typical wait updated if capacity changed.

Sources

1. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services (Pub. 100-02, Rev. 13889, issued July 30, 2026; section 220.3, Documentation Requirements for Therapy Services, and the section 220 definitions). Checked October 23, 2026.
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   “The Discharge Note (or Discharge Summary) is required for each episode of outpatient treatment.”; “The discharge note shall be a progress report written by a clinician, and shall cover the reporting period from the last progress report to the date of discharge.”; “In the case of a discharge unanticipated in the plan or previous progress report, the clinician may base any judgments required to write the report on the treatment notes and verbal reports of the assistant or qualified personnel.”; “In the case of a discharge anticipated within 3 treatment days of the progress report, the clinician may provide objective goals which, when met, will authorize the assistant or qualified personnel to discharge the patient.”; “The discharge note shall include all treatment provided since the last progress report and indicate that the therapist reviewed the notes and agrees to the discharge.”; “At the discretion of the clinician, the discharge note may include additional information; for example, it may summarize the entire episode of treatment, or justify services that may have extended beyond those usually expected for the patient’s condition.”; “Clinicians should consider the discharge note the last opportunity to justify the medical necessity of the entire treatment episode in case the record is reviewed.”; “The minimum progress report period shall be at least once every 10 treatment days.”; “It is not required that the referring or supervising physician/NPP sign the progress reports written by a PT, OT or SLP.”; “When unexpected discontinuation of treatment occurs, contractors shall not require a clinician’s participation in treatment for the incomplete reporting period.”; “Note that regression and plateaus can happen during treatment. It is recommended that the reasons for lack of progress be noted and the justification for continued treatment be documented if treatment continues after regression or plateaus.”; “The fact that services are typically billed is not necessarily evidence that the services are typically appropriate.”; “Also, some services or episodes of treatment should be less than those typically billed, when the individual patient reaches goals sooner than is typical.”; “The documentation guidelines in sections 220 and 230 of this chapter identify the minimal expectations of documentation by providers or suppliers or beneficiaries submitting claims for payment of therapy services to the Medicare program.”; “State or local laws and policies, or the policies or professional guidelines of the relevant profession, the practice, or the facility may be more stringent.”; “A re-evaluation is not a routine, recurring service”; “Indications for a re-evaluation include new clinical findings, a significant change in the patient’s condition, or failure to respond to the therapeutic interventions outlined in the plan of care.”; “A re-evaluation may be appropriate prior to planned discharge for the purposes of determining whether goals have been met, or for the use of the physician or the treatment setting at which treatment will be continued.”; “Current Procedural Terminology does not define a re-evaluation code for speech-language pathology; use the evaluation code.”; “an outpatient therapy episode is defined as the period of time, in calendar days, from the first day the patient is under the care of the clinician (e.g., for evaluation or treatment) for the current condition(s) being treated by one therapy discipline (PT, or OT, or SLP) until the last date of service for that discipline in that setting.”.
2. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services (Pub. 100-02, Rev. 13889, issued July 30, 2026; section 220.2, Reasonable and Necessary Outpatient Rehabilitation Therapy Services, subsections A, B and D (Maintenance Programs)). Checked October 23, 2026.
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   “Skilled therapy services may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition.”; “Medicare coverage does not turn on the presence or absence of a beneficiary’s potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care.”; “If a service can be self-administered or safely and effectively furnished by an unskilled person, without the direct or general supervision, as applicable, of a therapist, the service cannot be regarded as a skilled therapy service even though a therapist actually furnishes the service.”; “If the specialized skill, knowledge and judgment of a qualified therapist are required to establish or design a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration, the establishment or design of a maintenance program by a qualified therapist is covered.”; “If skilled therapy services by a qualified therapist are needed to instruct the patient or appropriate caregiver regarding the maintenance program, such instruction is covered.”; “A maintenance program can generally be performed by the beneficiary alone or with the assistance of a family member, caregiver or unskilled personnel. In such situations, coverage is not provided.”; “Unlike coverage for rehabilitation therapy, coverage of therapy services to carry out a maintenance program does not depend on the presence or absence of the patient’s potential for improvement from the therapy.”; “If skilled therapy services are needed for periodic reevaluations or reassessments of the maintenance program, such periodic reevaluations or reassessments are covered.”; “A patient with Parkinson’s disease is nearing the end of a rehabilitative physical therapy program and requires the services of a therapist during the last week(s) of treatment to determine what type of exercises will contribute the most to maintain function or to prevent or slow further deterioration of the patient’s present functional level following cessation of treatment.”; “In order for the therapist or therapy provider to transfer liability to the beneficiary, s/he must issue a valid ABN, Form CMS-R-131.”.
3. Centers for Medicare & Medicaid Services. Frequently Asked Questions (FAQs) Regarding Jimmo Settlement Agreement (CMS FAQ page, linked from the Jimmo Settlement page as its FAQs of August 2017). Checked October 23, 2026.
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   “A beneficiary’s lack of restoration potential cannot, in itself, serve as the basis for denying coverage under these benefits.”; “The Medicare program does not require a patient to decline before covering medically necessary skilled nursing or skilled therapy.”; “For a patient who had been expected to improve, but is no longer improving, a determination as to whether skilled care is needed to maintain the patient’s current condition or prevent or slow further deterioration must be made, and if such skilled care is needed, a plan of care to reflect the new maintenance goals must be developed.”; “If, however, a patient is no longer improving and there is no expectation of improvement and skilled care is not needed to maintain the patient’s current condition or to prevent or slow further deterioration, such skilled care services would not be covered.”; “some areas of the Medicare Benefit Policy Manual do identify certain vague phrases like ‘patient tolerated treatment well,’ ‘continue with POC,’ and ‘patient remains stable’ as being insufficiently explanatory to establish coverage”; “Medicare Advantage plans must cover the same Part A and Part B benefits as original Medicare, and must also apply the standards for coverage of skilled care as clarified by the Jimmo Settlement Agreement.”.
4. American Physical Therapy Association. Code of Ethics for the Physical Therapy Profession (policy page dated January 1, 2026, and the code’s PDF, apta-code-ethics-physical-therapy-profession.pdf). Checked October 23, 2026.
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   Standard of Conduct 4.4: “Physical therapists shall provide reasonable notice and information about alternative sources for obtaining care if the physical therapist terminates the provider relationship while the patient or client continues to need physical therapist services.”; Standard of Conduct 3.1: “Physical therapists and physical therapist assistants shall not exceed their professional, jurisdictional, and personal scopes of practice and shall communicate with, collaborate with, or refer to a peer or other health care professionals when necessary.”; the introduction: “The Standards of Conduct set forth in the Code of Ethics are used by the APTA Ethics and Judicial Committee to assess whether APTA members have engaged in unethical conduct.”; “Regulators and others may rely on the Code of Ethics in assessing the conduct of physical therapists and physical therapist assistants.”.
5. American Speech-Language-Hearing Association. Code of Ethics (ASHA policy document, effective March 1, 2023). Checked October 23, 2026.
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   “Effective March 1, 2023.”; Principle of Ethics I, Rule T: “Individuals shall give reasonable notice to ensure continuity of care and shall provide information about alternatives for care in the event that they can no longer provide professional services.”; Rule B: “Individuals shall use every resource, including referral and/or interprofessional collaboration when appropriate, to ensure that quality service is provided.”; Rule K: “Individuals who hold the Certificate of Clinical Competence shall evaluate the effectiveness of services provided, technology employed, and products dispensed, and they shall provide services or dispense products only when benefit can reasonably be expected.”; the preamble: “ASHA members who provide clinical services must hold the Certificate of Clinical Competence and must abide by the Code of Ethics.”.
6. Electronic Code of Federal Regulations. 45 CFR 164.524, Access of individuals to protected health information (HIPAA Privacy Rule, current text). Checked October 23, 2026.
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   (b)(2)(i): “the covered entity must act on a request for access no later than 30 days after receipt of the request”; (b)(2)(ii): “the covered entity may extend the time for such actions by no more than 30 days”; (b)(2)(ii)(A): “provides the individual with a written statement of the reasons for the delay and the date by which the covered entity will complete its action on the request”; (b)(2)(ii)(B): “The covered entity may have only one such extension of time for action on a request for access.”; (c)(2)(i): “The covered entity must provide the individual with access to the protected health information in the form and format requested by the individual, if it is readily producible in such form and format”; (c)(4): “the covered entity may impose a reasonable, cost-based fee, provided that the fee includes only the cost of:”.
7. Electronic Code of Federal Regulations. 42 CFR 422.566, Organization determinations (Medicare Advantage regulations, current text). Checked October 23, 2026.
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   (b): “An organization determination is any determination made by an MA organization with respect to any of the following:”; (b)(4): “Reduction, or premature discontinuation, of a previously authorized ongoing course of treatment.”; (c)(1)(ii), among those who may request one: “Any provider that furnishes, or intends to furnish, services to the enrollee; or”.
8. Electronic Code of Federal Regulations. 45 CFR 147.136, Internal claims and appeals and external review processes (current text, with the definition it adopts from 29 CFR 2560.503-1(m)(4)). Checked October 23, 2026.
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   “An adverse benefit determination means an adverse benefit determination as defined in 29 CFR 2560.503-1, as well as any rescission of coverage”; “The provisions of this section generally do not apply to coverage offered by health insurance issuers and group health plans that are grandfathered health plans”. 29 CFR 2560.503-1(m)(4)(i): “A denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit”.
9. Electronic Code of Federal Regulations. 16 CFR Part 465, Rule on the Use of Consumer Reviews and Testimonials (Federal Trade Commission rule, current text; § 465.4, Buying positive or negative consumer reviews). Checked October 23, 2026.
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   § 465.4: “It is an unfair or deceptive act or practice and a violation of this part for a business to provide compensation or other incentives in exchange for, or conditioned expressly or by implication on, the writing or creation of consumer reviews expressing a particular sentiment, whether positive or negative, regarding the product, service, or business that is the subject of the review.”.
10. American Speech-Language-Hearing Association. Documentation in Health Care (ASHA Practice Portal, professional issues). Checked October 23, 2026.
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    “Design a POC that includes short- and long-term measurable and functional goals, the anticipated length of treatment, discharge criteria, frequency and duration, and a home exercise program if applicable.”; “Determine when discharge from treatment is appropriate.”; “Confirm patient/caregiver participation and understanding of the diagnosis, treatment plan, strategies, precautions, and activities through ‘teach back’ and/or return demonstration.”; “Discharge summary notes are prepared at the conclusion of treatment and typically include dates of treatment, goals and progress toward goals, the treatment provided, objective measures (e.g., pre- and posttreatment evaluation results, outcome measures), functional status (see the link for the ICF framework above), patient/caregiver education provided, the reason for discharge, and recommendations for follow-up.”; “Private payers do not follow a universal documentation template.”.
11. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services (Pub. 100-02, Rev. 13889, issued July 30, 2026; section 220.1.3, Certification and Recertification of Need for Treatment and Therapy Plans of Care). Checked October 23, 2026.
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    “A physician/NPP may certify or recertify a plan for whatever duration of treatment the physician/NPP determines is appropriate, up to a maximum of 90 calendar days.”; “Treatment beyond the duration certified by the physician/NPP requires that a plan be recertified for the extended duration of treatment.”; “It is possible that patients will be discharged by the therapist before the end of the estimated treatment duration because some will improve faster than estimated and/or some were successfully progressed to an independent home program.”; “Recertification is not required if the duration of the initially certified plan of care is more than the duration (length) of the entire episode of treatment.”.
12. Centers for Medicare & Medicaid Services. Jimmo Settlement (CMS web page, Important Message About the Jimmo Settlement). Checked October 23, 2026.
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    “clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met).”; “The Jimmo Settlement Agreement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve.”; “does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.”; “The Jimmo Settlement Agreement does not alter or supersede any other applicable coverage requirements beyond those involving the need for skilled care”.
13. Centers for Medicare & Medicaid Services. Jimmo v. Sebelius Settlement Agreement Program Manual Clarifications Fact Sheet (fact sheet updated February 3, 2014, linked from CMS’s Jimmo Settlement page). Checked October 23, 2026.
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    “No ‘Improvement Standard’ is to be applied in determining Medicare coverage for maintenance claims in which skilled care is required.”; “denial notices for claims involving maintenance care in the SNF, HH, and OPT settings should contain an accurate summary of the reason for the determination, which should always be based on whether the beneficiary has a need for skilled care rather than on a lack of improvement.”.
14. Electronic Code of Federal Regulations. 42 CFR 424.24, Requirements for medical and other health services furnished by providers under Medicare Part B (paragraph (c), outpatient physical therapy, occupational therapy, and speech-language pathology services, current text). Checked October 23, 2026.
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    (c)(4)(i): “Recertification is required at least every 90 days.”; (c)(4)(iii): “The physician, nurse practitioner, clinical nurse specialist, or physician assistant who reviews the plan must recertify the plan by signing the medical record.”; (c)(5): “If the plan of treatment is established by a physical therapist, occupational therapist, or speech-language pathologist, and there is a written order or referral from the individual’s physician, nurse practitioner (NP), physician assistant (PA), or clinical nurse specialist (CNS) in the patient’s record and the therapist has documented evidence that the plan of treatment has been delivered to the physician, NP, PA, or CNS within 30 days of completion of the initial evaluation, the certification does not need to be signed by a physician, NP, CNS, or PA who has knowledge of the case.”; (c)(5): “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.”.
15. American Physical Therapy Association. Guidelines: Physical Therapy Documentation of Patient/Client Management (BOD G03-05-16-41, last updated May 19, 2014). Checked October 23, 2026.
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    “Documentation is required following conclusion of the current episode in the physical therapy intervention sequence, to summarize progression toward goals and discharge plans.”; “Documentation of discharge or discontinuation shall include the following elements:”; “Current physical/functional status.”; “Degree of goals achieved and reasons for goals not being achieved.”; “Discharge/discontinuation plan related to the patient/client’s continuing care. Examples include:”; “Home program.”; “Referrals for additional services.”; “Recommendations for follow-up physical therapy care.”; “Family and caregiver training.”; “Equipment provided.”.
16. American Occupational Therapy Association. Documentation (Practice Essentials page). “Occupational therapy documentation reflects the nature of services provided, shows the clinical reasoning of the occupational therapy practitioner, and provides enough information to ensure that services are delivered in a safe and effective manner.”. Checked October 23, 2026.
17. U.S. Department of Health and Human Services, Office for Civil Rights. Personal Representatives (HIPAA Privacy Rule guidance, 45 CFR 164.502(g); content last reviewed January 5, 2024). Checked October 23, 2026.
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    “In most cases under the Rule, a parent, guardian, or other person acting in loco parentis (collectively, ‘parent’) is the personal representative of the minor child and can exercise the minor’s rights with respect to protected health information, because the parent usually has the authority to make health care decisions about his or her minor child.”; “the Privacy Rule defers to State or other applicable laws that expressly address the ability of the parent to obtain health information about the minor child.”.
18. American Occupational Therapy Association. Ethics (Practice Essentials page, which links the AOTA 2025 Occupational Therapy Code of Ethics (doi:10.5014/ajot.2025.79S302, American Journal of Occupational Therapy) and lists “Client Abandonment” among its Ethics Advisory Opinions, which open to members after sign-in; AOTA’s Code of Ethics Core Values and Principles infographic (© 2025) is quoted last). Checked October 23, 2026.
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    “An official AOTA document, the AOTA Occupational Therapy Code of Ethics informs your practice, research, and education, to help occupational therapists, occupational therapy assistants, and students face complex ethical problems at various levels.”. The infographic: “Sanctionable offenses and violations of ethical standards are addressed separately under the Code’s Standards of Conduct, which outline specific and enforceable behaviors.”.
19. U.S. Department of Health and Human Services, Office for Civil Rights. Uses and Disclosures for Treatment, Payment, and Health Care Operations (HIPAA Privacy Rule guidance, 45 CFR 164.506; content last reviewed July 26, 2013). Checked October 23, 2026.
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    “‘Treatment’ generally means the provision, coordination, or management of health care and related services among health care providers or by a health care provider with a third party, consultation between health care providers regarding a patient, or the referral of a patient from one health care provider to another.”; “A covered entity may disclose protected health information for the treatment activities of any health care provider (including providers not covered by the Privacy Rule).”; “covered entities are not required to apply the minimum necessary standard to disclosures to or requests by a health care provider for treatment purposes.”.
20. U.S. Department of Health and Human Services, Office for Civil Rights. Your Medical Records (HIPAA guidance for individuals; content last reviewed May 30, 2025). Checked October 23, 2026.
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    “A health care provider or health plan may send copies of your records to another provider or health plan only as needed for treatment or payment or with your permission.”; “The Privacy Rule does not require the health care provider or health plan to share information with other providers or plans.”; “A provider cannot deny you a copy of your records because you have not paid for the services you have received.”; “However, a provider may charge for the reasonable costs for copying and mailing the records.”; “The provider cannot charge you a fee for searching for or retrieving your records.”.
21. U.S. Department of Health and Human Services, Office for Civil Rights. Covered Entities and Business Associates (HIPAA guidance for professionals; content last reviewed August 21, 2024). Checked October 23, 2026.
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    “If an entity does not meet the definition of a covered entity or business associate, it does not have to comply with the HIPAA Rules.”; “but only if they transmit any information in an electronic form in connection with a transaction for which HHS has adopted a standard.”.
22. U.S. Department of Health and Human Services, Office for Civil Rights. Important Notice Regarding Individuals’ Right of Access to Health Records (HHS notice on Ciox Health, LLC v. Azar, No. 18-cv-0040 (D.D.C. January 23, 2020)). Checked October 23, 2026.
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    “a federal court vacated the ‘third-party directive’ within the individual right of access”; “beyond requests for a copy of an electronic health record”; “in an electronic format.”; “the fee limitation set forth at 45 C.F.R. § 164.524(c)(4) will apply only to an individual’s request for access to their own records, and does not apply to an individual’s request to transmit records to a third party.”; “The right of individuals to access their own records and the fee limitations that apply when exercising this right are undisturbed and remain in effect.”.
23. U.S. Department of Health and Human Services, Office for Civil Rights. Does the HIPAA Privacy Rule require covered entities to keep patients’ medical records for any period of time? (HIPAA FAQ; content last reviewed July 26, 2013). Checked October 23, 2026.
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    “No, the HIPAA Privacy Rule does not include medical record retention requirements. Rather, State laws generally govern how long medical records are to be retained.”; “the HIPAA Privacy Rule does require that covered entities apply appropriate administrative, technical, and physical safeguards to protect the privacy of medical records and other protected health information (PHI) for whatever period such information is maintained by a covered entity, including through disposal.”.
24. Electronic Code of Federal Regulations. 34 CFR 300.2, Applicability of this part to State and local agencies (IDEA Part B regulations, current text). Checked October 23, 2026.
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    (a): “This part applies to each State that receives payments under Part B of the Act, as defined in § 300.4.”; (b)(2): “Are binding on each public agency in the State that provides special education and related services to children with disabilities, regardless of whether that agency is receiving funds under Part B of the Act.”.
25. Electronic Code of Federal Regulations. 34 CFR 104.31, Application of this subpart (Section 504 regulations of the U.S. Department of Education, subpart D, current text). Checked October 23, 2026.
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    “Subpart D applies to preschool, elementary, secondary, and adult education programs or activities that receive Federal financial assistance and to recipients that operate, or that receive Federal financial assistance for the operation of, such programs or activities.”.
26. Centers for Medicare & Medicaid Services. Therapy Services (CMS web page; its Bipartisan Budget Act of 2018 section was last revised in February 2026 for the CY 2026 KX modifier thresholds). Checked October 23, 2026.
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    “Section 50202 of the BBA of 2018 repeals application of the Medicare outpatient therapy caps and its exceptions process while adding limitations to ensure payment for appropriate therapy services.”; “the law preserves the former therapy cap amounts as thresholds above which claims must include the KX modifier as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record.”; “Claims for services over the KX modifier threshold amounts without the KX modifier are denied.”; “$2,480 for PT and SLP services combined, and”; “$2,480 for OT services.”.
27. Centers for Medicare & Medicaid Services. FFS ABN (Beneficiary Notices Initiative; page last modified July 17, 2026). Checked October 23, 2026.
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    “The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service - FFS) beneficiaries in situations where Medicare payment is expected to be denied.”; “The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances.”.
28. Electronic Code of Federal Regulations. 42 CFR 438.400, Statutory basis, definitions, and applicability (Medicaid managed care grievance and appeal system, current text). (b): “Adverse benefit determination means, in the case of an MCO, PIHP, or PAHP, any of the following:”; (b)(2): “The reduction, suspension, or termination of a previously authorized service.”. Checked October 23, 2026.
29. Electronic Code of Federal Regulations. 45 CFR 149.610, Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals (current text). Checked October 23, 2026.
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    (b)(1)(vi)(C): “When a good faith estimate is requested by an uninsured (or self-pay) individual: Not later than 3 business days after the date of the request.”; (b)(1)(vi)(A): “When a primary item or service is scheduled at least 3 business days before the date the item or service is scheduled to be furnished: Not later than 1 business day after the date of scheduling;”; (b)(1)(x): “A convening provider or convening facility may issue a single good faith estimate for recurring primary items or services”; (b)(1)(x)(B): “The scope of a good faith estimate for recurring primary items or services must not exceed 12 months.”; (a)(2)(xiii)(B), defining one kind of uninsured (or self-pay) individual: “An individual who has benefits for such item or service under a group health plan”; and, later in the same clause: “but who does not seek to have a claim for such item or service submitted to such plan or coverage.”.
30. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services (Pub. 100-02, Rev. 13889, issued July 30, 2026; section 40.4, Definition of Physician/Practitioner, in the rules on private contracts and opting out). Checked October 23, 2026.
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    “Physical therapists in independent practice and occupational therapists in independent practice cannot opt out because they are not within the opt out law’s definition of either a ‘physician’ or ‘practitioner’.”.
31. American Speech-Language-Hearing Association. A Guide to Mandatory Medicare Enrollment for Audiologists and SLPs in Private Practice (ASHA News, December 5, 2025). “Unlike some other health care providers (like physicians), audiologists and SLPs cannot ‘opt out’ of Medicare or enter into private pay arrangements with Medicare patients.”. Checked October 23, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy practice, not legal, compliance, billing or financial advice. Medicare, HIPAA, payer and state rules apply to each practice’s own facts, and its examples are hypothetical, not DrSensory data or benchmarks.