To answer this question, consider the following:

Will improvements made at the impairment level lead to improvements in this patient’s functional abilities? Ie. Even if this patient gets stronger, will it likely lead to an improvement in a current functional deficit, like the ability to stand up from the toilet?
Are expected improvements likely to be achieved in a reasonable amount of time? This is where you’ll need to use your clinical judgement to determine if there are potential barriers to progress that might impact this patient’s potential. Ie. Even if this patient could get stronger, and potentially lead to an improvement in ability to sit to stand from the toilet, it will likely take an unreasonable about of time due to limited carryover due to poor follow through with clinician recommendations.
If you can answer YES to both of these conditions, choose the YES block below.
If the answer to any of these conditions is NO, whether due to the barriers to progress OR due to presence of an unstable or progressive condition limiting potential for improvement, answer NO.
For further information related to determining Medical Necessity, refer to the Medicare Policy Manual Chapter 15, Section 220.2, Reasonable and Necessary Outpatient Rehabilitation Therapy Services.