RE: Driving assessments -- Does Medicare cover them?

[Guest guest]

Leigh,

The best LCD I've seen on this topic is the NGS OT/PT LCD.

Here is a link to the LCD:

Local Coverage Determination (LCD) for Outpatient Physical and Occupational

Therapy Services (L26884)

http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=268\

84 & ContrId=181 & ver=80 & ContrVer=1 & CntrctrSelected=181*1 & Cntrctr=181 & name=National\

+Government+Services%252c+Inc.+(13202%252c+MAC+-+Part+ & DocStatus=Active & s=41 & b\

c=AggAAAIAAAAA & This is the LCD for NY; the same policy is in place in

multiple states but not in all states for all contractors. I see that you are

in California; I am not aware of similar language in the Palmetto PM & R LCD, yet.

In terms of the NGS LCD:

See this language under the OT evaluation section:

* Driving assessments provided under an occupational therapy plan of care

are covered only when there is a reasonable expectation that the patient's

ability to drive will be restored or improved. The need for the assessment must

be related to the presence of, or recovery from, a specific injury or illness.

Generalized aging, weakness or debility do not qualify as Medicare covered

conditions for assessment or therapy services. Assessment for the sole purpose

of disqualifying a patient from driving is not a covered benefit.

See this language under the description for 97537

Under the Occupational Therapy benefit, this service may be covered for the

provision of compensatory training of patients in driving techniques. The

patients must be identified as meeting Medicare criteria for coverage:

* the need for therapy is a result of an identified injury or illness, NOT

simply generalized aging, weakness or debility;

* the need for therapy must be demonstrated by an assessment which shows the

patient has a reasonable expectation of being able to drive a vehicle after

being treated under an occupational therapy plan of care;

* assessments performed only for the purpose of disqualifying the patient

from driving are not a covered benefit.

This article has some additional context:

http://www.aota.org/News/Centennial/40313/Advocacy/Advocate.aspx

Chuck Willmarth

Director, State Affairs and Reimbursement & Regulatory Policy

American Occupational Therapy Association

4720 Montgomery Lane, Suite 200

Bethesda, land 20814-3449

x-2019 (direct)

cwillmarth@...

From: PTManager [mailto:PTManager ] On Behalf Of

leighallenpt

Sent: Monday, July 30, 2012 8:46 PM

To: PTManager

Subject: Driving assessments -- Does Medicare cover them?

Does anyone know if Medicare will pay for simulated driving assessments

performed by an OT? How is it coded?

Thank you!

Leigh , PT, MSPT

San Francisco, CA

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