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:
Original Determination Ending Date:
Revision Effective Date:
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, §18.104.22.168 Observation and Assessment of the Patient's Condition When Only the Specialized Skills of a Medical Professional Can Determine Patient's Status, §22.214.171.124 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, §126.96.36.199 Certification Requirements, §6.2.2 Physician Recertification, §188.8.131.52 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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