Medicare group therapy, concurrent therapy, and co-treatment, in CMS’s words
CMS describes these terms in two different documents for two different settings, and this page keeps them apart. For Part B outpatient therapy, the Medicare Benefit Policy Manual, Chapter 15, section 230, describes group therapy services as services provided at the same time to two or more individuals, with the therapist in constant attendance. For skilled nursing facility residents, CMS’s MDS 3.0 RAI Manual defines individual, concurrent, and group therapy and co-treatment, with separate Part A and Part B definitions. Both cover physical therapy, occupational therapy, and speech-language pathology. No payment amounts or billing codes are copied.
Quoted from official pages checked November 10, 2026. Confirm current requirements, fees, and dates on those sites. This page is not legal advice and does not guarantee eligibility, certification, or licensure.
Two CMS sources were read on November 10, 2026: the Medicare Benefit Policy Manual, Chapter 15 (PDF; table of contents Rev. 13889, issued July 30, 2026), section 230 A (Rev. 63), and the MDS 3.0 RAI User’s Manual, version 1.20.11 (PDF, October 2026), Chapter 3, Section O, item O0390. They are quoted separately and are not reconciled. No CMS MLN or fact page on these terms was quoted.
Part B outpatient therapy: Chapter 15
Section 230 A, “Group Therapy Services”, states: “Contractors pay for outpatient physical therapy services (which includes outpatient speech-language pathology services) and outpatient occupational therapy services provided simultaneously to two or more individuals by a practitioner as group therapy services”. It continues: “The individuals can be, but need not be performing the same activity. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one patient contact is not required.”
The parts of Chapter 15 read for this site do not use the terms concurrent therapy or co-treatment for outpatient therapy. What section 230 says about students during group therapy is on therapy students and Medicare.
SNF residents: the RAI Manual’s therapy modes
The RAI Manual states: “For any therapy that does not meet one of the therapy mode definitions below, those minutes may not be counted on the MDS.” Its definitions follow, Part A and Part B side by side where the manual gives both.
Individual therapy
“The treatment of one resident at a time. The resident is receiving the therapist’s or the assistant’s full attention.”
Concurrent therapy
Medicare Part A: “The treatment of 2 residents who are not performing the same or similar activities at the same time, regardless of payer source, both of whom must be in the line of sight of the treating therapist or assistant.”
Medicare Part B: “The treatment of two or more residents who may or may not be performing the same or similar activity, regardless of payer source, at the same time is documented as group treatment.”
Group therapy
Medicare Part A: “The treatment of two to six residents, regardless of payer source, who are performing the same or similar activities and are supervised by a therapist or assistant who is not supervising any other individuals.”
Medicare Part B: “The treatment of 2 or more individuals simultaneously, regardless of payer source, who may or may not be performing the same activity.”
Co-treatment
For Part A: “When two clinicians (therapists or therapy assistants), each from a different discipline, treat one resident at the same time with different treatments, both disciplines may code the treatment session in full.” It continues: “The decision to co-treat should be made on a case-by-case basis and the need for co-treatment should be well documented for each patient. Because co-treatment is appropriate for specific clinical circumstances and would not be suitable for all residents, its use should be limited.”
For Part B: “Therapists, or therapy assistants, working together as a ‘team’ to treat one or more patients cannot each bill separately for the same or different service provided at the same time to the same patient.” It also states: “Where physical and occupational therapists both provide services to one patient at the same time, only one therapist can bill for the entire service, or the PT and OT can divide the service units.” The manual’s billing-code example is not copied.
Where the two documents differ, for example in how many people a Part A group may include, the wording above is each document’s own. Other SNF rules are on working in nursing homes.
What this page does not do
It does not copy payment amounts, billing codes, or minute thresholds, and it does not tell anyone how to code a session. It is not legal, billing, or compliance advice. Confirm current rules with the agency that publishes them, your employer, and your state board.