Home-based Medicare-covered physical therapy, occupational therapy and speech-language pathology services may be available outside of Medicare’s often inaccessible home health benefit. Mobile outpatient therapy is coverable under Part B, though it cannot be billed alongside other home health services.
The Home Health Benefit
The Medicare home health benefit covers a mix of services, including nursing, physical therapy, occupational therapy, speech language pathology, social work, and home health aide services. There is no duration of time limit to the benefit. Under the law, beneficiaries can receive home health coverage for as long as they remain “homebound,” in need of skilled care, and under an appropriate plan of care.
Regrettably, in practice – despite this coverage law – beneficiaries have long struggled to access the necessary amount of coverable home health services, particularly in cases where they are living with long-term conditions and need on-going services. The Center for Medicare Advocacy has materials on its website to assist beneficiaries in understanding when home health care should be covered and how to appeal unlawful terminations of services. But even with increased advocacy, countless beneficiaries go without needed and coverable home health care. A major reason for this gap in service is the payment model for home health providers, which encourages limited, short-term care.
Mobile Outpatient Therapy
Outpatient therapy providers may choose to offer mobile services either exclusively or in addition to office-based services. Under Medicare policy, therapy services are payable under the same fee schedule when furnished either in the beneficiary’s home or in a facility’s outpatient department. See Chapter 15 § 220.1.4 of the Medicare Benefit Policy Manual. These services are coverable when medically necessary, ordered by a physician or authorized health care provider, and provided under a plan of care. There are no frequency nor duration limits.
Finding an outpatient therapy provider that offers mobile service may not be easy. While providers can elect to offer mobile services to assist more clients, they are not paid extra by Medicare for travel. Currently, there is no directory of Medicare-enrolled mobile outpatient therapy providers. There are, however, providers located sporadically across the country. Beneficiaries may find that these providers are more willing to serve individuals with long-term conditions who need on-going services.
Choosing Between the Two
Mobile outpatient therapy cannot be billed to Medicare alongside home health services; home health’s bundled payments prevent it, even if the home health provider is not offering therapy services. Since home-based nursing, social work, and home health aide services are not separately coverable under Part B, beneficiaries choosing mobile outpatient therapy over home health services are forgoing the possibility of Medicare coverage for this greater range of services.
Mobile outpatient therapy is potentially available to more beneficiaries since there is no homebound requirement. Again, the decision of whether to offer mobile services rests with individual providers.
Home health providers and outpatient therapy providers have different payment incentives. The home health model pays providers based on beneficiary need rather than provided services, creating an incentive for providers to offer less services in certain cases. On the other hand, outpatient therapy providers are paid per service, but not for travel.
There are also likely to be different out-of-pocket costs for beneficiaries receiving home health versus mobile outpatient therapy services. Medicare Part B typically covers 80% of the cost of outpatient therapy after the deductible is paid, whereas Medicare, whether Part A or B, typically covers 100% of the cost of home health services. Other factors affecting cost may include whether the beneficiary is enrolled in a Medigap or Medicare Advantage Plan.
Conclusion
The home health benefit is failing to meet the Medicare population’s need for home-based services. Outpatient therapy providers can step up to fill in some of the gaps, but beneficiaries may be missing out on more comprehensive care.
August 14, 2025 – E. Krupa
