CMS 700 Form – Fill Out and Use This PDF

CMS 700 Form PDF Details

The CMS-700 is the official Plan of Treatment for Outpatient Rehabilitation used by Medicare. Therapists and certifying physicians complete it before billing Medicare Part B for physical, occupational, or speech-language pathology services in outpatient settings. Filling it out correctly protects the patient's benefits and the provider's reimbursement.

What Is the CMS 700 Form

The CMS 700 is a two-page federal document published by the Centers for Medicare and Medicaid Services. It serves as the formal record of a patient's outpatient therapy plan, capturing the diagnosis, goals, treatment frequency, and expected duration. Medicare requires a signed plan of treatment before it will pay for any outpatient therapy session, which makes this document the foundation of every Part B therapy claim.

The form replaces informal treatment plans when billing Medicare. Without a properly certified copy on file, claims are subject to denial during post-payment audits. Keeping a signed plan in the patient record for every active episode of care is a basic compliance requirement for any therapy practice that accepts Medicare.

Who Completes This Form

Treating therapists complete the clinical portion, documenting diagnosis codes, functional limitations, measurable goals, and the estimated duration of care. A physician or qualified non-physician practitioner must then review the plan and sign the certification block before Medicare reimburses for services.

Outpatient rehabilitation facilities, private therapy clinics, and hospital-based outpatient departments all rely on this document to initiate billing. Home health agencies that deliver distinct-part outpatient services to Medicare Part B beneficiaries also use it to document each episode of care.

Key Fields in the Plan of Treatment

The form is organized into several sections, each capturing a distinct category of clinical and administrative data. The patient section collects the full name, Medicare health insurance claim number, date of birth, and sex. Providers enter diagnosis codes, the onset date of the condition, and the start-of-care date in the clinical section.

Functional level descriptions at the start of the billing period document the patient's baseline deficits and current abilities. Therapy goals must be stated in objective, measurable terms so that progress can be evaluated at each recertification visit. The treatment plan section specifies the types of therapy, visit frequency, and projected duration. For example, a plan might call for two visits per week for six weeks of physical therapy. The certifying physician signs the bottom of the form to attest that the services are medically necessary.

Certification and Recertification

Medicare requires the plan to be certified within 30 days of the therapy evaluation. Recertification is required at least every 90 days throughout an active episode of care. Missing a certification deadline is among the most common compliance errors identified during audits. Providers may have to refund payments for services rendered during uncertified periods, making timely renewals a priority for every outpatient therapy practice.

At recertification, the physician must review updated clinical findings and confirm that continued therapy is still warranted. The updated plan should reflect any changes in diagnosis, functional status, or therapy goals since the last certification.

Related Medicare Outpatient Forms

Outpatient therapy programs often require additional documentation alongside the plan of treatment. Providers who bill therapy services submit claims using the CMS 1500 claim form. Before drafting the plan, therapists typically complete a physical therapy intake form to gather the patient's baseline clinical history. Speech-language pathologists follow a parallel documentation process using a speech therapy treatment plan that mirrors the same certification requirements.