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.

QuestionAnswer
Form Name CMS 700 Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names 700 medicare form, you cms 700 form, form cms 700, cms 700 forms

How to Edit CMS 700 Form Online for Free

Getting Started

Open the PDF editor by clicking the "Get Form" button at the top of this page. The editor lets you type directly into all fields, correct existing entries, and attach a digital signature without any software installation. FormsPal uses an encrypted connection and does not store any personal data you enter while working on the document.

Before you begin, gather the following information: the patient's Medicare identification number, the treating therapist's NPI, the ICD-10 diagnosis code for the patient's condition, and the planned frequency and duration of therapy. Having these details ready will allow you to complete the document in a single session.

Step 1: Patient and Provider Information

Begin by entering the patient's identifying details at the top of the form. These include the full name and Medicare health insurance claim number, date of birth, and sex. Below that, enter the rendering provider's name, the National Provider Identifier (NPI), and the facility address where therapy services are delivered. Confirm that the facility type matches the outpatient rehabilitation setting noted on the therapist's credentials.

human cms 700 form conclusion process shown (step 1)

Step 2: Diagnosis, Assessment, and Goals

Enter the ICD-10 diagnosis code that best describes the patient's condition requiring therapy. Record the date of onset and the start-of-care date in the designated fields. In the INITIAL ASSESSMENT History area, summarize the patient's functional limitations and the clinical background that led to the referral for outpatient therapy.

Document PRIOR HOSPITALIZATION dates when the current episode follows a recent inpatient stay, since this context affects the baseline functional level recorded at the start of care. The FUNCTIONAL LEVEL fields need a measurable description of the patient's current abilities and deficits. State goals in objective terms. For example: "Patient will ambulate 150 feet with a standard cane and minimal assistance within six weeks." In the CONTINUE SERVICES OR DC SERVICES block, indicate whether the plan calls for ongoing therapy or discharge at the end of the billing period.

Step no. 2 for filling out human cms 700 form

Step 3: Service Dates and Certification

The SERVICE DATES section requires the FROM date and the THROUGH date for the billing period. Verify that these dates match the visit log in the patient's record. The Form CMS identifier and revision date must match the version on file. Review all entries before the physician or qualified non-physician practitioner signs the certification block, because errors in service dates are a leading cause of Medicare claim denials for outpatient therapy providers.

Stage number 3 for filling out human cms 700 form

Finishing and Downloading Your Form

After reviewing every field, click "Done" to finalize the document in the FormsPal editor. You can then download the completed PDF, print it for a wet-signature certification, or share it electronically with the supervising physician for countersignature. All changes are saved automatically so you can return to correct any field before the plan is certified and placed in the patient record.

Once the certifying physician has signed, file the original in the patient's medical record and retain a copy for the billing department. If the plan is recertified every 90 days, create a tickler file or calendar reminder to ensure no billing period begins without a current, signed plan on file.

Related Forms for Outpatient Therapy

Outpatient therapy programs often need additional documents alongside the plan of treatment. Chiropractic practices serving Medicare patients use a chiropractic treatment plan form that follows a similar structure for Medicare Part B episodes. Speech-language pathology services are authorized with a speech therapy treatment plan that mirrors the certification process. When a new patient arrives for an initial evaluation, a physical therapy intake form captures the full clinical history before the therapist drafts the plan of treatment.

Frequently Asked Questions

What is the purpose of the CMS 700 form?

It documents the Medicare patient's plan of treatment for outpatient physical, occupational, or speech-language pathology therapy. Medicare requires a signed and dated plan before it reimburses for outpatient rehabilitation services under Part B.

How often must the plan be recertified?

The plan must be initially certified within 30 days of the therapy evaluation and recertified at least every 90 days while the patient continues to receive outpatient rehabilitation services. Missing a recertification deadline can result in claim denials for the uncertified period.

Who signs the plan of treatment?

A physician or qualified non-physician practitioner, such as a physician assistant or nurse practitioner, must review the plan and sign the certification block. The certifying provider must have examined the patient or reviewed pertinent clinical findings in the record before signing.

Can this form be filled out online?

Yes. Open the PDF in the FormsPal editor, complete all required fields, add a signature, and download the finished document. You can then print the signed copy for the certifying physician or share it electronically for countersignature before submitting it with the Medicare claim.

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