Ask a PT Response: "Medicare is a federal program and guidelines should not vary from state to state. A formal progress note/reassessment needs to be performed every 10th visit or 30 days which ever is sooner. The formal progress note/reassessment should be completed again after the next 10 visits (20 visits) or 30 days (60 days) and so on if the patient continues to be seen longer. When having the plan of care signed off by the physician, if additional time is required than what was signed off by the physician, another plan of care must be submitted to the physician to sign off on. I hope this makes sense and helps answer your question."