Medicare home health therapy rules: qualifying, OT’s continuing need, and 30-day reassessments
Chapter 7 of CMS’s Medicare Benefit Policy Manual sets the rules for home health. A patient qualifies by being confined to the home, under the care of a physician or allowed practitioner, under a plan of care, and needing intermittent skilled nursing, physical therapy, or speech-language pathology, or having a continuing need for occupational therapy. Occupational therapy can continue a home health case when, as section 30.4 states, “The patient's eligibility for home health services has been established by virtue of a prior need for skilled nursing care (other than solely venipuncture for the purposes of obtaining a blood sample), speech-language pathology services, or physical therapy in the current or prior certification period.” For each therapy discipline, a qualified therapist, not an assistant, must assess the patient at the start and reassess at least every 30 days. No payment rates are copied.
Quoted from official pages checked November 10, 2026. Confirm current requirements, fees, and dates on those sites. This page is not legal advice and does not guarantee eligibility, certification, or licensure.
Sources read on November 10, 2026: the Medicare Benefit Policy Manual, Chapter 7 – Home Health Services (PDF; table of contents Rev. 12425, issued 12-21-23), sections 30, 30.1.1, 30.4, 40.2, and 40.2.1 through 40.2.4; and 42 CFR 409.44 on eCFR (up to date as of 11/06/2026). Who employs home health therapists, and Medicare.gov’s list of covered home health services, are on working in home health.
The qualifying conditions
Section 30 states that, to qualify, a beneficiary must: “Be confined to the home;”, be “Under the care of a physician or allowed practitioner;”, be “Receiving services under a plan of care established and periodically reviewed by a physician or allowed practitioner;”, “Be in need of skilled nursing care on an intermittent basis or physical therapy or speech-language pathology; or” “Have a continuing need for occupational therapy.” It adds: “A patient must meet each of the criteria specified in this section.”
On homebound status, section 30.1.1 states that “the law requires that a physician or allowed practitioner certify in all cases that the patient is confined to his/her home.” Its second criterion reads: “There must exist a normal inability to leave home;” and “Leaving home must require a considerable and taxing effort.”
Occupational therapy as a continuing need
Section 30.4 states that a patient has a continued need for occupational therapy when the services meet the manual’s definition of occupational therapy and “The patient's eligibility for home health services has been established by virtue of a prior need for skilled nursing care (other than solely venipuncture for the purposes of obtaining a blood sample), speech-language pathology services, or physical therapy in the current or prior certification period.”
Its example describes a patient recovering from a stroke whose next certification period orders only occupational therapy and home health aide services: “The patient's need for occupational therapy qualifies him for home health services, including home health aide services (presuming that all other qualifying criteria are met)”.
What makes therapy skilled
Section 40.2 states: “Coverage does not turn on the presence or absence of an individual’s potential for improvement, but rather on the beneficiary’s need for skilled care.” Section 40.2.1 states: “The service of a physical therapist, speech-language pathologist, or occupational therapist is a skilled therapy service if the inherent complexity of the service is such that it can be performed safely and/or effectively only by or under the general supervision of a skilled therapist.” It adds that “a patient's diagnosis or prognosis should never be the sole factor in deciding that a service is or is not skilled.”
It also states: “Services involving activities for the general welfare of any patient, e.g., general exercises to promote overall fitness or flexibility and activities to provide diversion or general motivation do not constitute skilled therapy.” And it requires that “The home health record must specify the purpose of the skilled service provided.”
Initial assessment and 30-day reassessment
Section 40.2.1 states: “For each therapy discipline for which services are provided, a qualified therapist (instead of an assistant) must assess the patient’s function using a method which objectively measures activities of daily living such as, but not limited to, eating, swallowing, bathing, dressing, toileting, walking, climbing stairs, using assistive devices, and mental and cognitive factors.”
On reassessment, the manual states: “At least once every 30 days, for each therapy discipline for which services are provided, a qualified therapist (instead of an assistant) must provide the ordered therapy service, functionally reassess the patient, and compare the resultant measurement to prior assessment measurements.” It adds: “The 30-day clock begins with the first therapy service (of that discipline) and the clock resets with each therapist’s visit/assessment/measurement/documentation (of that discipline).”
The regulation, 42 CFR 409.44(c)(2)(i)(B), states: “At least every 30 calendar days a qualified therapist (instead of an assistant) must provide the needed therapy service and functionally reassess the patient”. The manual says 30 days; the regulation says 30 calendar days. Both are left as written.
Restorative and maintenance therapy
Section 40.2.1(d) says one of three conditions must be met, the first being that “The skills of a qualified therapist, or by a qualified therapist assistant under the supervision of a qualified therapist, are needed to restore patient function”. The other two cover designing and carrying out a maintenance program; CMS’s maintenance policy is on skilled maintenance therapy and Jimmo.
For speech-language pathology, section 40.2.3 states that services “are covered when the individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified speech-language pathologist are necessary.” Section 40.2.4 states the same for “a qualified occupational therapist”.
What this page does not do
It does not copy payment rates, case-mix or period amounts, or billing codes, and does not say whether any patient qualifies. It is not legal, billing, or compliance advice. Confirm current rules with the agency or organization that publishes them, your employer, and your state board.