Medicare Agreement

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I understand the following regarding Medicare’s coverage for physical therapy services:

Medicare does NOT have a Cap for Outpatient Physical Therapy services for 2024. Coverage is based on medical necessity.

The Medicare deductible for 2024 is $240.00; this is patient responsibility.

Once a treatment amount of $2330.00 has been met, Medicare will require additional documentation from the provider(s) to notate medical necessity.

Medicare requires that the patient be under the direction of a physician and have a valid plan of care (physician’s order) on file.

Biomechanix Physical Therapy will follow and bill according to Medicare guidelines.

Patient Name (print)*

First Name Last Name

Patient/Guardian Signature*

Date*