Medicare AdvantageCoverageMedium impact
Outpatient Rehabilitation (Skilled Therapy) - Medicare Advantage (Revised)
Humana·Physical Therapy, Occupational Therapy, Speech Therapy·Medicare Advantage
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
This is a revised Medicare Advantage policy for Outpatient Rehabilitation (Skilled Therapy) covering Physical Therapy, Occupational Therapy, and Speech-Language Pathology services. The policy became effective 07/01/2026 and includes coverage guidelines for therapeutic modalities, Low Level Laser Therapy (LLLT), and High Power Laser Therapy (HILT). The document provides references to applicable CMS guidance, MAC-specific LCDs by geographic jurisdiction, and related coverage policies for nerve stimulation and pain management therapies.
Action Required
By 06/30/2026: Billing and clinical teams must review this revised policy in detail. (1) Identify which MAC jurisdiction(s) apply to your practice locations using the jurisdiction table provided (MACs J5, J6, J8, J15, JE, JF, JJ, JM, JN). (2) Cross-reference the applicable MAC's LCD (Local Coverage Determination) for your region to understand specific coverage rules, medical necessity requirements, and billing guidance for PT, OT, and SLP services. (3) Update internal workflows and prior authorization templates to align with the therapy coverage limitations and conditions outlined in this policy. (4) Educate providers on documentation requirements per IOM Pub. 100-02, Chapter 15, §220.3 to ensure claims include medical necessity justification. (5) Review coverage for laser therapy modalities (LLLT and HILT) — these may require specific documentation of medical necessity and may not be covered under all circumstances. (6) Ensure billing staff understand that this policy may be modified by individual member coverage documents — verify patient benefits before processing therapy claims. Failure to comply with MAC-specific LCDs will result in claim denials.