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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 11004 Contractor Type: HHH MAC

LCD Information

LCD ID Number: L34560 Status: A-Approved LCD Title: Home Health Occupational Therapy Geographic Jurisdiction: Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, New Mexico, Ohio, Oklahoma, South Carolina, Tennessee, Texas Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 06/09/2022 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act, §1814(a)(2)(C) requirement of requests and certifications Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member 42 CFR §409.32 Criteria for skilled services and the need for skilled services 42 CFR §409.42 Beneficiary qualifications for coverage of services 42 CFR §409.43 Plan of care requirements 42 CFR §424.22 Requirements for home health services CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 7, §20.1.2 Determination of Coverage, §30.4 Needs Skilled Nursing Care on an Intermittent Basis (Other than Solely Venipuncture for the Purposes of Obtaining a Blood Sample), Physical Therapy, Speech-Language Pathology Services, or Has Continued Need for Occupational Therapy, §40.2.1 General Principles Governing Reasonable and Necessary Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy, §40.2.4 Application of the General Principles to Occupational Therapy, §40.2.4.1 Assessment, §40.2.4.2 Planning, Implementing, and Supervision of Therapeutic Programs, §40.2.4.3 Illustration of Covered Services, §50.1 Skilled Nursing, Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 8, §40.1 Who May Sign the Certification or Recertification for Extended Care Services CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §220 Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance, §220.1.4 Requirement That Services Be Furnished on an Outpatient Basis, §220.2 Reasonable and Necessary Outpatient Rehabilitation Therapy Services and §230.2 Practice of Occupational Therapy CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 1, §10.2 Transcutaneous Electrical Nerve Stimulation (TENS) for Acute Post-Operative Pain, §30.1 Biofeedback Therapy and §30.1.1 Biofeedback Therapy for the Treatment of Urinary Incontinence CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §150.8 Fluidized Therapy Dry Heat for Certain Musculoskeletal Disorders, §160.7 Electrical Nerve Stimulator, §160.7.1 Assessing Patients Suitability for Electrical Nerve Stimulation Therapy, §160.12 Neuromuscular Electrical Stimulator (NMES), §160.13 Supplies Used in the Delivery of Transcutaneous Electrical Nerve Stimulation (TENS) and Neuromuscular Electrical Stimulation (NMES), §160.15 Electrotherapy for Treatment of Facial Nerve Palsy (Bell’s Palsy) and §160.27 Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 3, §170.1 Institutional and Home Care Patient Education Programs CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, §240.3 Heat Treatment, Including the Use of Diathermy and Ultra-Sound for Pulmonary Conditions, §270.1 Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds and §270.6 Infrared Therapy Devices CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 6, §6.2 Medical Review of Home Health Services, §6.2.1 Physician Certification of Patient Eligibility for the Medicare Home Health Benefit, §6.2.1.1 Certification Requirements, §6.2.2 Physician Recertification, §6.2.2.1 Recertification Elements, §6.2.3 The Use of the Patient’s Medical Record Documentation to Support the Home Health Certification, §6.2.5 Medical Necessity of Services Provided, §6.2.6 Examples of Sufficient Documentation Incorporated Into a Physician’s Medical Record and §6.2.7 Medical Review of Home Health Demand Bills Sorry, you need to login or register to view additional sections of this Medicare policy. *