6 Essential Criteria You Must Meet to Get Insurance Reimbursement for Medical Exercise Training

As the need for Medical Exercise Training (MET) continues to rise, private insurance carriers are slowly opening the door to reimbursing these valuable services.

But before you submit your first claim, there’s one critical question to answer:

Does your client—and your service—meet the necessary criteria?

After 31 years of educating Medical Exercise Professionals and working within the healthcare ecosystem, we’ve identified a six-point checklist every MET case must meet before an insurance company even reviews the claim.

Let’s break them down:

1. A Valid Medical Referral

You must have a written referral from a licensed medical provider:

• MD (Doctor of Medicine)

• DO (Doctor of Osteopathic Medicine)

• DPM (Doctor of Podiatric Medicine)

• Nurse Practitioner or Physician Assistant (under the supervision of an MD or DO)

No referral? No claim.

2. Completion of Professional Rehab

The client must have already received the maximum benefit from:

• Physical Therapy (PT)

• Occupational Therapy (OT)

• Chiropractic care

If they’re still eligible for those services, insurance expects them to complete them first.

3. Chronic Condition, Surgery, or Trauma

One of the following must be present:

• Post-surgical recovery

• Major trauma (e.g., motor vehicle accident, fracture)

• A chronic medical condition (e.g., arthritis, diabetes, Parkinson’s)

4. Residual Functional Deficits

Even after formal rehab ends, if the client still struggles with functional limitations, they may qualify for MET services. Think: difficulty with walking, climbing stairs, or lifting.

5. Non-Medicare/Medicaid Clients

At this time, Medicare and Medicaid do not recognize Medical Exercise Professionals for reimbursement. Focus your insurance-based services on clients with private insurance only.

6. Documented Goals and a Structured Plan

The MedExPRO must:

• Outline short- and long-term goals

• Create a specific, written exercise plan based on the client’s deficits

Without this documentation, your claim will be denied—or worse, approved and later audited.

Why This Matters

Many claims are denied because MedExPROs didn’t know or didn’t follow this checklist. And even worse, some are audited months later, resulting in demands for repayment if these six points aren’t met.

Let’s avoid that.

Join Us This Friday – Free Webinar!

Want to go deeper into these criteria and see real-world documentation examples?

👉 Register now for our free Cracking the Code Webinar
🗓️ Friday, April 25th
🕛 12 Noon ET
🌐 www.crackingthecode.net

This 20–30 minute session could save you thousands in lost revenue or denied claims—and help you establish a reimbursement-ready MET practice.