Medicare typically covers an intensive outpatient program (IOP) for up to 90 days per episode. This duration is subject to clinical eligibility and physician certification.
To maintain and potentially extend this coverage, several requirements must be met:
- Medical Necessity: A physician must certify that the program is medically necessary for your recovery.
- Physician Recertification: Medicare may require periodic recertification by a physician to extend coverage beyond the initial period. At Recovery Cove, the clinical team manages this process, typically performing progress reviews every 60 to 90 days to document the ongoing need for care.
- Treatment Plan: Coverage requires a formal, individualized treatment plan that outlines specific therapeutic goals and session frequency.
In comparison, Medicare coverage for a Partial Hospitalization Program (PHP) — which is a more intensive level of care — typically lasts for up to 180 days per benefit period.
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