However, if coding and documentation illustrates the hip fracture was caused by a fall and the fall was due to a cognitive deficit, treatment may be covered. Without appropriate documentation and coding, the service may be denied because there is no clear connection between the hip fracture and the need for cognitive treatment. For example, a patient who was hospitalized for a hip fracture subsequently receives cognitive treatment in the SNF. As such, it is critical for SLPs and the SNF to delineate a clear tie to the prior hospitalization through accurate coding and documentation.
Moca test cpt code manual#
See also: Medicare Home Health Prospective Payment SystemĬhapter 8 of the Medicare Benefit Policy Manual for skilled nursing facilities (SNFs) allows for coverage of speech-language pathology services when the condition arises after admission to the SNF or when the need for treatment ties directly to the prior acute care hospitalization.
Moca test cpt code mac#
Absent direct Medicare guidance, work with the home health agency and the local MAC to verify coverage guidelines for cognitive services. There is also a limited number of home health LCDs that address speech-language pathology services. However, there is no reference to cognitive services. Medicare Part A covers services provided in inpatient, facility-based settings as well as services provided under a home health plan of care.Ĭhapter 7 of the Medicare Benefit Policy Manual for the home health benefit clearly outlines coverage for speech-language pathology services associated with speech, language, and swallowing disorders. Absent specific Medicare guidance regarding cognitive evaluation and therapy, SLPs should verify coverage with their local MAC and follow the Medicare Physician Fee Schedule (MPFS), generally accepted coding guidelines, and national guidelines as outlined in Medicare manuals, such as the Medicare Benefit Policy Manual. However, many local Medicare Administrative Contractors (MACs) do delineate a role for SLPs in this area of treatment through local coverage determinations (LCDs). Medicareįederal laws and regulations governing the provision of speech-language pathology services under Medicare do not as clearly define the role of SLPs in treating cognitive impairments as they do for speech, language, voice, and swallowing disorders. It is also critical for SLPs to establish medical necessity for cognitive evaluation and treatment services and provide clear documentation to support the need for the skilled care. Which Current Procedural Terminology (CPT® American Medical Association) and International Classification of Diseases (ICD) codes are eligible for cognitive services.Whether there are requirements for prior authorization or specific visit limits.Whether other factors contribute to level of coverage (e.g., the patient’s underlying medical condition or the setting in which services are provided).What provider types are eligible to provide cognitive services.Whether cognitive evaluation and therapy services are covered.SLPs should seek guidance in the following areas: Generally, SLPs can find payer coverage guidelines in medical policy documents related to speech-language pathology services or cognitive therapy/rehabilitation. Policies are often limited to services for patients diagnosed with specific medical conditions-such as stroke or traumatic brain injury (TBI)-and may also exclude cognitive services for specific conditions such as mild TBI, developmental disorders, or neurodegenerative diseases.Īlways verify payer coverage policies before providing cognitive evaluation and therapy services. It is important for SLPs to understand that there is significant variability in coverage for services for patients with cognitive impairments. It is critical for speech-language pathologists (SLPs) to understand coverage policies for the payers they commonly bill, to verify coverage for each patient prior to initiating services, and to be familiar with appropriate diagnosis and procedure coding for accurate claims submission. Payment and coverage of speech-language pathology services related to the evaluation and treatment of cognitive impairments varies widely based on factors such as the patient’s medical condition, the payer, and the patient’s specific health insurance plan. Considerations for Speech-Language Pathologists
0 kommentar(er)
