CodeMap® 
150 North Wacker Drive
Suite 1870
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax
customerservice@codemap.com
      


User Information

Create New Account

Lost Password

Username:
Password:


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule

2022
2021

Physician Fee Schedule

2022
2021

OPPS Fee Schedule

2022-October
2022-July

ASC Fee Schedule

2022-October
2022-July

APC Codes

2022-October
2022-July

DRG Codes

2022
2021

ASP Drug Pricing Files

October 2022
July 2022


CMS Transmittals



CodeMap® LCD-L34560

 

Printer Friendly Version

L34560
LCD for Home Health Occupational Therapy (L34560)
See related Articles:
A53053-Billing and Coding: CPT Code 97755 - Assistive Technology Assessment
A53057-Billing and Coding: Home Health Occupational Therapy

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, New Mexico, North Carolina, 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.

--
*
All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.

12/01/2022 01:21:26 34.239.154.240


CodeMap® is a Registered Trademark of Wheaton Partners, LLC.