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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: L34563 Status: A-Approved LCD Title: Home Health Speech-Language Pathology 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: 05/11/2023 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 and 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, §40.1.2.1 Observation and Assessment of the Patient's Condition When Only the Specialized Skills of a Medical Professional Can Determine Patient's Status, §40.1.2.3 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 Determinations (NCD) 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 Determinations (NCD) 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 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. *