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Meeting Medicare's Medical Necessity Requirement

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published September 2017

Non-Member Price:  $5

Member Price:  FREE on website

FORMAT:  This is an ELECTRONIC DOCUMENT. You will not be mailed a hard copy. When you purchase this document, you'll receive a download link by email where you may download and save a copy.

This 31-page electronic document (PDF) provides guidance related to determining homebound status and medical necessity. It includes case studies, and decision-making trees related to compliance with Medicare's medical necessity requirements for home care. Although this guide is intended for physical therapists and the case studies included focus on physical therapy, other therapists and therapy supervisors may find the information relevant.

Case studies and decision-making trees are included for the following for purposes of providing models for common diagnoses and case complexities:

  • Patient with below knee amputation (BKA) following recent hospital stay for treatment of pneumonia
  • Patient post hospital stay due to an orthopedic condition
  • Patient with recent hip fracture and urinary tract infection with Type II diabetes
  • Patient with heart failure
  • Patient with Parkinson's Disease


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