Medicare Qualifying Diagnosis

Is Inpatient Rehabilitation right for you? The following are requirements from CMS (Medicare) to qualify for Inpatient Rehabilitation. Your physician can help you by making a recommendation based on your condition.

Patient MUST have a qualifying diagnosis such as:

  • Stroke
  • Amputation
  • Brain injury
  • Spinal cord injury
  • Major multiple trauma
  • Neurological disorders (Parkinson’s disease, Guillain-Barre, etc.)
  • Hip fracture (limited)
  • Other debilitating conditions (limited)

Patient MUST have medical necessity requiring physician attention and rehab nursing during rehab stay such as, but not limited to:

  • Cardiac, pulmonary or neurological medical needs
  • HTN, anemia, dysphagia, oxygen desaturation, uncontrolled diabetes, etc.
  • New diagnosis requiring teaching
  • Incontinence

Patient MUST be able to tolerate 3 hours of therapy daily for 5 of 7 days.

  • Therapy is not done in 3 hour blocks, but done throughout the day

Benefits of Inpatient Rehabilitation

There are many benefits to inpatient rehabilitation, including:

  • Inpatient Rehab builds strength, endurance, independence and confidence with a goal of returning patients to their prior level of function in the community.
  • Administering intensive rehab helps patients return home and avoid extended stays in nursing homes.
  • Inpatient Rehab builds confidence regarding safety at home and provides teaching regarding new diagnosis.