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LCD for Home Health Speech-Language Pathology (L34563)
See related Articles:
A53052-Billing and Coding: Home Health Speech-Language Pathology

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: L34563 Status: A-Approved

LCD Title: Home Health Speech-Language Pathology

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: 05/26/2022

Revision End Date:

CMS National Coverage Policy:

Title XVIII of the Social Security Act, §1814(a)(2)(C) Requirements 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

Title XVIII of the Social Security Act, §1862(a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups

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. 100-01, Medicare General Information, Eligibility, Entitlement Manual, Chapter 1, §10.2 Home Health Services

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 7, §30.1.1 Patient Confined to the Home, §30.1.2 Patient's Place of Residence, §30.2.1 Definition of Allowed Practitioner, §30.2.2 Content of the Plan of Care, §30.3 Under the Care of a Physician or Allowed Practitioner, §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, § Observation and Assessment of the Patient's Condition When Only the Specialized Skills of a Medical Professional Can Determine Patient's Status, § Teaching and Training Activities, §40.2 Skilled Therapy Services, §40.2.1 General Principles Governing Reasonable and Necessary Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy, §40.2.3 Application of the General Principles to Speech-Language Pathology Services, and §50.1 Skilled Nursing, Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determination Manual, Chapter 1, Part 1, §50.1 Speech Generating Devices, §50.2 Electronic Speech Aids, §50.3 Cochlear Implantation, and §50.4 Tracheostomy Speaking Valve

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determination Manual, Chapter 1, Part 3, §170.2 Melodic Intonation Therapy and §170.3 Speech-Language Pathology Services for the Treatment of Dysphagia

CMS Internet-Only Manual, Pub. 100-08, Medicare Integrity Program 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, § Certification Requirements, §6.2.2 Physician Recertification, § 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

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12/01/2022 02:54:30

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