Home health physical therapy has more scheduling rules than most disciplines, because PTs often open the case, often share it with a PTA, and often carry the patients who need the most visits early on. The visits themselves are the job. The rules decide which day each one has to land.
This guide is for the home health PT who plans their own week, alone or with a PTA. It covers when you open the case and what that sets off, how to plan PTA visits around your 30-day visit, how front-loaded orders change the week, and recerts and discharges. For the general system, start with how to manage a home health caseload.
A note on who is writing. I'm an occupational therapist, not a PT, and the founder of Logicly, a home health scheduling app for clinicians. Everything below is Medicare's rule or plain practice; state practice acts can add to it.
The Short Answer
- In a therapy-only case, you open it. The initial visit is due within 48 hours of the referral or on the ordered start of care date, and the comprehensive assessment within 5 days.
- Your 30-day visit is the one to plan on purpose. When a PTA treats, you must see the patient at least every 30 calendar days.
- Front-loaded orders change week by week. 3w2, 2w2, 1w2 means your week's count for that patient drops every two weeks.
- Recerts fall in the last 5 days of the period and go to whoever is responsible for the comprehensive assessment.
- Want a tool that knows the order, not one where you count visits by hand.
When You Open the Case
When rehabilitation therapy is the only service ordered, the therapist may make the initial assessment visit and do the comprehensive assessment (42 CFR 484.55(a)(2) and (b)(3)). In a physical therapy case that is you. Two clocks start:
| Clock | When | Source |
|---|---|---|
| Initial assessment visit | Within 48 hours of the referral, within 48 hours of the patient's return home, or on the ordered start of care date | 42 CFR 484.55(a)(1) |
| Comprehensive assessment, including OASIS | No later than 5 calendar days after the start of care | 42 CFR 484.55(b)(1) |
A start of care visit is the longest visit of the episode. Give it a slot where running over doesn't make you late for a patient with a fixed time, and do not stack two in a day if you can help it. If your agency sends an RN for a non-billable nursing assessment in a therapy-only case, that visit has to happen the same day as your first visit or within five days after it; the start of care date explained covers the detail.
When nursing is ordered as well, the registered nurse makes the initial assessment visit, and your evaluation follows. Ask the office when the RN's visit is booked, so your evaluation lands soon after it.
Planning PTA Visits Around Your 30-Day Visit
With a PTA on the case, the rule that shapes your week is the reassessment:
At least every 30 calendar days a qualified therapist (instead of an assistant) must provide the needed therapy service and functionally reassess the patient. (42 CFR 409.44(c)(2)(i)(B))
The clock starts with the first physical therapy visit and resets each time you see the patient. Counting starts the day after your visit: a reassessment on April 1 means you must be back by May 1. There is no grace period, and visits after a missed deadline are not covered until you reassess. The 30-day rule in full has the counting and the edge cases.
How to plan it:
- Book the next 30-day visit at the reassessment, for around day 21 to 28. CMS's own on-time examples are the 21st or 28th day. A visit planned for day 30 has no room for a sick day.
- Make it one of the week's ordered visits. Your visit counts against the physical therapy frequency like the PTA's do. In a 2w4 week with a reassessment, you make one visit and the PTA makes the other.
- Keep the PTA's visits apart from yours in the same week, so the patient isn't seen on back-to-back days by two people for the same order.
- Check your state's rules. Some state practice acts set their own PTA supervision visit intervals or on-site requirements on top of Medicare's.
Info
A PTA visit is a physical therapy visit. There is no separate PTA order: the PTA works under the physical therapy order and counts against its frequency. Which order an assistant works under explains why.
Front-Loaded Orders
Post-surgical and post-hospital patients often get more visits early. An order like 3w2, 2w2, 1w2 asks for three visits in each of the first two weeks, two in each of the next two, and one in each of the last two. Read each block as visits per week times number of weeks: 6 + 4 + 2 = 12 visits over 6 weeks.
What this does to your week:
- Your total moves every two weeks even when nobody is admitted or discharged. Re-count the week from the orders, not from last week's schedule.
- Three-visit weeks fill fast. A caseload with several 3w patients needs Monday, Wednesday and Friday for them, and the rest goes on Tuesday and Thursday.
- Watch the end of the period. The order's weeks have to fit inside the 60-day certification period. If they run past day 60, the visits beyond it need a recertification and new orders.
If a frequency is unfamiliar, home health visit frequencies explained reads each format, and the frequency calculator shows where every visit falls in the 60 days.
Recerts and Discharges
The recertification assessment has to be done in the last 5 days of every 60-day period, counted from the start of care (42 CFR 484.55(d)(1)). For a period that ends on a Saturday, that is Tuesday to Saturday. In a therapy-only case where you are responsible for the comprehensive assessment, the recert is yours. Plan it early in the window, so a cancellation still leaves you two or three days.
Discharges are easier to miss than recerts because nothing forces the date. When the goals are met and the frequency is ending, put the discharge visit on the calendar the week before, and tell the office so the other disciplines know.
A PT's Week at a Glance
| Put on the calendar first | Then | Then |
|---|---|---|
| Starts of care due within 48 hours | Patients with blocked times | Routine visits, a day apart for each patient |
| Recerts in their 5-day window | Patients who must be seen with someone else (a joint visit with a PTA or a caregiver) | Each day in driving order |
| Your 30-day visits, around day 21 to 28 | A spare slot most days | |
| Discharges |
How to plan a week of home health visits works this order through a full example week from a PT's caseload.
What to Want From a Scheduling App
For a PT, a home health scheduling app earns its place if it does the arithmetic above for you: reads 3w2, 2w2, 1w2 as written, knows which week the patient is in, works out the cert period and recert window from the start of care, and puts each day in driving order.
In Logicly, you type the order on a patient's Frequency tab the way it is written and press Apply; the cert period is already there, 60 days from the start of care, and the recert window is worked out. The visits the week still needs wait in the visit pool, and Auto-schedule week spreads them across your working days, never back to back for the same patient, with each day in driving order. Each visit has a type, from start of care and evaluation to routine, reassessment, recertification and discharge, with its own length that you set. Logicly is built for the clinician who plans their own visits: it shows your own caseload, not your PTA's, so plan the PTA's visits with them. You can try it on sample patients without signing up, and we compare the other options in the best home health apps for clinicians.
Type 3w2, 2w2, 1w2 and get the week
Logicly reads frequencies as you write them, works out the cert period and recert window, and places each week's visits in driving order.
Key Takeaways
- In a therapy-only case the PT opens it: the initial visit within 48 hours of referral or on the ordered date, the comprehensive assessment within 5 days.
- With a PTA treating, you must see the patient at least every 30 calendar days. Book it for day 21 to 28, and count it as one of the week's ordered visits.
- Front-loaded orders change your weekly count every block. Count each week from the order.
- Recerts land in the last 5 days of the period. Plan early in the window.
- Your state's practice act can add PTA supervision rules on top of Medicare's.
Frequently asked questions
Can a physical therapist do the start of care in home health?
Yes, when therapy is the only service ordered. Under 42 CFR 484.55(a)(2), when rehabilitation therapy is the only service ordered, the initial assessment visit and the comprehensive assessment may be made by the appropriate therapist, which for a physical therapy case is the PT. When nursing is ordered too, the registered nurse does the initial assessment.
How often does a home health PT have to see a patient a PTA is treating?
At least every 30 calendar days. A qualified physical therapist, instead of the assistant, has to provide the therapy service and functionally reassess the patient (42 CFR 409.44(c)(2)(i)(B)). The clock starts with the first physical therapy visit and resets with each visit by the PT. Your state's practice act may ask for more, so check its PTA supervision rules too.
Can a PTA do the first visit after the PT evaluation?
Yes. Once the PT has assessed the patient and set the goals, the PTA's treatment visits are covered physical therapy visits and count against the physical therapy frequency. What a PTA may not do is the evaluation, the 30-day reassessment visit in place of the PT, or any comprehensive assessment and OASIS.
What is a typical home health PT frequency after a joint replacement?
There is no standard order; the frequency comes from the evaluation and the practitioner's order. Many plans are front-loaded, with more visits in the first weeks and fewer later, such as 3w2, 2w2, 1w2. Whatever the order, the visits have to fit inside the 60-day certification period, and each week's count is what you schedule against.
Sources
- 42 CFR 484.55 (opens in a new tab): (a)(1) initial assessment visit; (a)(2) and (b)(3) the therapist in a therapy-only case; (b)(1) comprehensive assessment within 5 days; (d)(1) recertification in the last 5 days of every 60 days.
- 42 CFR 409.44(c) (opens in a new tab): (1)(i) goals set by a qualified therapist; (2)(i)(A) initial assessment by a qualified therapist; (2)(i)(B) reassessment at least every 30 calendar days instead of an assistant.
- CMS, Medicare Benefit Policy Manual, Chapter 7 (opens in a new tab), section 40.2.1: the 30-day clock and when it resets.
- Related on this site: which order an assistant works under, the 30-day therapy reassessment rule, the 48-hour rule for referrals.