Therapy Requirements for Skilled Nursing Facilities in 2025

What happens when a referral comes in for a patient who might need physical therapy every day, but your staffing is already stretched thin — and you're still waiting on complete documentation?

For skilled nursing facilities (SNFs), that scenario is fairly routine, but it puts you in a tough spot: Delay the response and risk losing the referral, or say yes without knowing if your team can actually deliver the care.

This article is here to help you figure out that conundrum. We’ll walk through what qualifies a patient for SNF therapy, how therapy services are structured and reimbursed, and what compliance looks like under Medicare in 2025 — so you can make faster, smarter decisions without compromising care.

Here’s what we’ll cover:

• Qualifications for Skilled Nursing Facility (SNF) therapy

• Therapy requirements for a skilled nursing facility

• Physical therapy (PT) guidelines and expectations

• Medicare coverage and reimbursement rules for SNF PT

What qualifies a patient for skilled nursing care?

Not every patient leaving the hospital is a fit for a skilled nursing facility — and SNFs know that better than anyone. But when you’re trying to move fast on referrals, it helps to have a clear understanding of what actually qualifies a patient for skilled care under Medicare and other payers.

Here's what matters most when determining eligibility.

Medical conditions and healthcare needs

A patient typically qualifies for SNF care if they require daily skilled services that can’t be provided at home or in an outpatient setting. This might include:

• Post-surgical care (e.g., orthopedic rehab, wound care)

• Stroke recovery with ongoing therapy needs

• Management of complex medical conditions requiring skilled nursing (e.g., IV meds, tube feeding)

• Monitoring after acute hospitalization for conditions like COPD, CHF, or pneumonia

These services must be reasonable and necessary for treating the patient’s condition — this is a Medicare requirement, not just a best practice. 

Also, speaking of rehab, inpatient rehab is not the same as SNF care since inpatient rehab stays are shorter and include many more frequent therapy sessions.

Medicare and insurance requirements

To qualify under Medicare Part A in 2025, patients must:​

• Meet the current hospitalization requirements, which may not necessitate a three-day inpatient stay under specific circumstances.​
  
  

• Be admitted to the SNF within the updated timeframe as specified by Medicare guidelines.​
  
  

• Obtain a physician’s certification confirming the need for daily skilled care.​

For a deeper dive into coverage, see our article on how many days Medicare pays for a skilled nursing facility.

Physician recommendations and assessment guidelines

A physician’s order alone doesn’t guarantee SNF PT eligibility, but it is essential. Clinical judgment must be supported by documentation that shows:

• The patient’s functional status

• Skilled interventions needed (e.g., physical therapy, wound care)

• Anticipated progress or goals of care

Many SNFs also conduct an internal clinical and financial screen before accepting a referral. This is where platforms like ExaCare can help by pulling the relevant information from lengthy referral packets into a simple summary for faster decisions.

Therapy requirements for a skilled nursing facility

Physical therapy in a skilled nursing facility is tightly regulated, carefully documented, and often time-sensitive. Plus, since therapy needs are one of the biggest factors in whether you can safely accept a patient, knowing the requirements helps you protect both your census and your care quality.

Here’s what you need to know.

Types of therapy covered in SNFs

Skilled nursing facilities typically provide:

• Physical Therapy (PT): Focuses on improving mobility, strength, balance, and pain management.
  
  

• Occupational Therapy (OT): Helps patients regain the ability to perform activities of daily living (ADLs) like dressing or bathing.
  
  

• Speech-Language Pathology (SLP): Assists with speech, cognition, swallowing, and communication issues.

Patients may need just one of these or a combination, depending on their condition and care goals.

Frequency, duration, and intensity of therapy sessions

There are no strict minimum time requirements, but therapy plans must be clinically justified. Factors that affect frequency and intensity include:

• The patient’s initial evaluation and baseline function

• Their tolerance for therapy sessions

• Expected improvement based on evidence-based guidelines

Therapy may occur 5 to 7 days per week in some cases, or just a few times weekly in others. The key is that it must be reasonable, necessary, and tailored to the patient’s condition.

Documentation and care plan requirements

Accurate documentation is critical, not just for compliance, but also to ensure continuity of care and justify therapy services during audits. Requirements generally include:

• A complete therapy evaluation and plan of care

• Measurable treatment goals

• Progress notes at regular intervals (often weekly)

• Justification for continued services

SNFs must also show that skilled therapy is helping the patient improve or helping maintain function in cases where decline would occur without intervention (this is known as maintenance therapy). Detailed documentation is essential when providing maintenance therapy in order to get coverage from Medicare or Medicaid.

How long does Medicare cover physical therapy in an SNF?

Under Medicare Part A, patients are eligible for up to 100 days of SNF coverage per benefit period. The cost-sharing structure is as follows:​

• Days 1–20: Fully covered by Medicare.​

• Days 21–100: Subject to a daily coinsurance amount, which is updated annually.​

However, SNF therapy services don’t automatically continue through all 100 days. Coverage ends when the patient no longer meets the criteria for skilled care, even if they haven’t hit the full 100 days. That’s why clear documentation, timely evaluations, and regular progress updates are so important.

Under the Patient-Driven Payment Model (PDPM), implemented in 2019 and updated in 2025, SNF reimbursement is determined by patient characteristics such as diagnoses, functional status, and comorbidities, rather than the volume of therapy minutes provided.​

This shift was designed to:

• Reduce unnecessary therapy

• Encourage interdisciplinary care

• Focus on patient complexity rather than therapy volume

However, facilities still need to ensure therapy is well-documented and appropriately delivered. Over- or under-delivering therapy services (especially without supporting documentation) can raise red flags.

For more on PDPM, check out our PDPM guide.

Physical therapy in skilled nursing facilities

Physical therapy plays a central role in skilled nursing care, and it’s often the deciding factor for whether a patient can safely discharge home or remain in long-term care.

For SNFs, that means PT is a key driver of outcomes, compliance, and referrals.

Role and goals of PT

In the SNF setting, the goal of physical therapy is to help patients regain function and independence after hospitalization or illness. Common therapy goals include:

• Restoring mobility after surgery (e.g., hip or knee replacements)

• Improving balance and preventing falls

• Building strength to support walking, transfers, or daily activities

• Reducing pain and managing chronic conditions like arthritis

Therapists also work with patients to prevent decline, especially for those with degenerative conditions who may not "improve" in the traditional sense but benefit from maintenance therapy.

Patient evaluation and treatment planning

Every patient begins with a thorough PT evaluation, which sets the foundation for a personalized care plan. The evaluation includes:

• Functional assessments (e.g., gait, transfers, strength)

• Range of motion testing

• Pain assessments

• Short- and long-term therapy goals

• Expected discharge outcomes

Plans must be realistic, measurable, and updated as the patient progresses or plateaus.

SNF physical therapy: Compliance and Medicare guidelines

Physical therapy in SNFs comes with strict guidelines — especially under Medicare. Additionally, with reimbursement models shifting, staying compliant while delivering effective therapy takes more than just good intentions. It takes clear documentation, an understanding of coverage rules, and close attention to patient progress.

Medicare Part A vs. Part B Coverage

Most short-stay SNF patients receive therapy under Medicare Part A, which covers up to 100 days of care following a qualifying hospital stay. This includes therapy, nursing, room and board, and other services bundled into a per diem rate.

Once Part A benefits are exhausted (or if the patient doesn’t meet Part A criteria) Medicare Part B may cover outpatient-style therapy. Under Part B:

• Therapy is billed separately.

• Frequency and duration must still be medically necessary.

• Co-pays and deductibles may apply.

SNFs need systems in place to track when patients shift from Part A to Part B and ensure documentation reflects that change.

Therapy caps, exceptions, and rules

Medicare applies annual thresholds for therapy services, but exceptions are available when services are deemed medically necessary. Therapists must provide thorough documentation to justify services exceeding these thresholds.​

Lack of detail or unclear goals is a common reason for claim denials or audits.

How SNFs can optimize therapy services

In order to make therapy requirements for skilled nursing facility effective at scale, you need the right mix of staffing, systems, and smart use of technology.

Staff training and certification requirements: Therapists in SNFs must hold appropriate state licensure and meet CMS qualifications. Beyond that, facilities benefit when therapy teams are trained in SNF-specific documentation standards, Medicare compliance, and PDPM-related care planning.

Ongoing education helps prevent costly errors and supports better outcomes.

Effective management of therapy schedules: When caseloads are high, staying on top of therapy sessions can get chaotic fast. Strong scheduling systems ensure patients are seen consistently, interdisciplinary teams are aligned, and documentation stays timely. It's also key to avoiding missed visits that can impact reimbursement or discharge timelines.

ExaCare helps SNFs match incoming patients to the therapy resources they actually have, so facilities don’t accept patients whose needs they can’t meet. The platform uses AI to scan hospital referrals, highlight therapy intensity, and flag resource requirements like ortho or stroke rehab.

Instead of flipping through long documents or toggling between referral portals, admissions teams get a clear picture upfront.

With ExaCare, facilities can make quicker, more informed decisions and reduce delays that impact hospital partnerships and reimbursement.

Frequently asked questions

Can therapy services continue if a patient stops improving?

Yes. Medicare allows maintenance therapy in SNFs if it helps prevent decline, as long as skilled care is still needed and properly documented.

Can a patient receive multiple types of therapy simultaneously in an SNF?

Yes. Patients often receive a combination of physical, occupational, and speech therapy if it's clinically appropriate and well documented.

Are there specific guidelines for therapy session length?

No fixed time requirement exists under PDPM, but session length must be clinically justified and tied to the patient’s care plan.

How frequently must SNF therapy progress notes be updated?

Progress notes are typically required at least every 7 days, or more often if the patient’s condition changes or goals are modified.

ExaCare helps match the right patients to your therapy capabilities

Everything we’ve covered about therapy requirements for skilled nursing facilities, from qualifications to compliance rules, points to one simple reality: You can only provide great care if you have the right resources in place for the resident.

And in a fast-moving referral environment, making that match isn’t always easy.

Some SNFs can only take residents who align with their therapy capabilities, based on staffing levels, equipment, or clinical specialization. But without a clear view into what’s in the referral packet, that decision gets delayed or rushed, and that’s when mistakes happen.

ExaCare helps solve that.

ExaCare uses AI to scan hospital referrals and summarize key clinical and therapy needs — so your team sees, upfront, whether a resident is the right fit. Whether you're screening for rehab intensity, stroke recovery needs, or therapy frequency, ExaCare pulls it all into a single, easy-to-understand view.

Here’s what we offer:

• AI-powered referral screener that reviews hospital packets in minutes, enabling quick and accurate admissions decisions
  
  

• Centralized referral management that brings all your sources into one platform
  
  

• Built-in analytics to help you track performance and optimize your referral relationships
  
  

• Automated insurance verification, expensive med alerts, and reimbursement analyses to guard your bottom line.
  
  

•  A unified communication hub to streamline decision-making with colleagues.

ExaCare makes it easier to admit the right patients faster, without sacrificing care quality or stretching your team too thin.

Ready to see how we can support your therapy admissions process?

Schedule a demo.