Frequently Asked Questions About the LSVT BIG® Program at Banyan & Nomad

At Banyan & Nomad, we view Parkinson’s care as ongoing. Tune-ups are important for maintaining progress. We often follow up by phone, coordinate with physicians, or schedule check-ins every few months.

1. Does Medicare cover the full LSVT BIG protocol if it includes 16 sessions?

Yes, it can—when it’s done right. Medicare doesn’t cap the number of visits just because a program includes 16 sessions. What matters most is whether the sessions are medically necessary and clearly documented. At Banyan & Nomad, our therapists are trained to show exactly how our Parkinson’s patients are progressing, using clear functional goals and outcome-driven evidence. When care is delivered with skill and backed by research (like the 16-session dosage of LSVT BIG), Medicare recognizes its value.

2. My agency only allows 1-2 therapy visits per week. Does that rule out LSVT BIG?

Not necessarily. LSVT BIG is a high-frequency model, but many patients in home health have complex needs—especially those in later stages of Parkinson’s. We often split the plan of care between physical and occupational therapy, using OASIS data to show the need for skilled services at a higher frequency. We also emphasize front-loading visits (4 sessions/week early on) to make the most of those first 30 days. That structure benefits outcomes, reduces rehospitalization risk, and helps with reimbursement.

3. Will PDGM (Patient-Driven Grouping Model) affect our ability to deliver LSVT BIG at home?

PDGM changes the way Medicare pays for home health, but it doesn’t reduce the value of therapy. At Banyan & Nomad, our Parkinson’s patients often fall into complex nursing groupings with comorbidities that allow for therapy inclusion. We prioritize a strong first 30-day plan with higher visit frequency and track functional progress to support recertification if needed. When done right, LSVT BIG not only fits into PDGM—it helps drive better outcomes, which is exactly what the model rewards.

Implementation Questions

1. Can LSVT BIG really be used in a home setting with more advanced patients?

Absolutely. Parkinson’s doesn’t look the same in every person. Some home health patients are homebound due to recent illness or surgery; others are in later stages of the disease. LSVT BIG is flexible. We adjust for stage, ability, and setting while still focusing on movement quality and safety. Our therapists are trained to deliver the program with compassion and creativity, and we always work closely with caregivers when needed. Whether someone is newly diagnosed or living with later-stage PD, we meet them where they are.

2. What if 60-minute sessions, four times a week, are too much for my patient?

Not all patients will tolerate the full schedule right away, and that’s okay. At Banyan & Nomad, we tailor the session structure based on individual tolerance. That might mean shorter holds, fewer reps, or adapting movements to seated or supported positions. We never compromise the quality of care—we adjust the delivery to help the patient succeed. And often, once patients experience a few sessions, they rise to the challenge and gain confidence quickly.

3. My patient doesn’t have anyone to help with their home exercises. What now?

It’s a common concern. In home health, we work to build a support system around the patient. That might include family, neighbors, or connecting through community resources like local Parkinson’s groups, churches, or aging services. If needed, our therapists may involve social workers to explore more options. We also recommend tools like the LSVT BIG Homework Helper videos and other home-friendly resources to support independent practice.

If your patient is in assisted living or a senior community, we’ll communicate with the facility manager to find creative solutions. Many communities are open to supporting care that reduces fall risk and keeps residents safe and engaged.

4. How do I know if a patient’s dementia is too advanced for LSVT BIG?

It depends on the individual. We use tools like the MoCA or SLUMS to assess cognitive function. If a patient is in the moderate to advanced stages, we often include caregivers in the training process. Even when memory is affected, patients can still benefit from movement-based learning, external cues, and repetition. With the right support, LSVT BIG can still improve safety, reduce falls, and bring structure to everyday tasks.

5. How should we handle tune-ups or follow-up sessions in home health?

At Banyan & Nomad, we view Parkinson’s care as ongoing. Tune-ups are important for maintaining progress. We often follow up by phone, coordinate with physicians, or schedule check-ins every few months. If we notice changes in function or mobility, we work with the care team to re-initiate therapy. Having a structure in place for long-term support—even beyond the initial plan of care—keeps our patients engaged and helps prevent setbacks.

By working closely with referral sources and families, we make sure that our Parkinson’s patients have access to the right care at the right time, not just when there’s a crisis.

Note: LSVT BIG® is a registered trademark of LSVT Global, Inc.
Banyan & Nomad is certified to deliver LSVT BIG and proudly follows its evidence-based standards