|
CPT codes, descriptions and other data only are copyright 2007
American Medical Association (or such other date of publication of CPT). All
Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental
Terminology, (CDT) (including procedure codes, nomenclature, descriptors
and other data contained therein) is copyright by the American Dental
Association. © 2002, 2004 American Dental Association. All rights reserved.
Applicable FARS/DFARS apply.
|
|
CMS Pub. 100-03, Medicare National Coverage Determinations Manual,
Chapter 1, Part 4, Section 280.1
|
|
For any item to be covered by Medicare, it must 1) be eligible for
a defined Medicare benefit category, 2) be reasonable and necessary for the
diagnosis or treatment of illness or injury or to improve the functioning
of a malformed body member, and 3) meet all other applicable Medicare
statutory and regulatory requirements. For the items addressed in this
medical policy, the criteria for "reasonable and necessary" are
defined by the following indications and limitations of coverage and/or
medical necessity.
For an item to be covered by Medicare, a written signed and dated order
must be received by the supplier before a claim is submitted. If the
supplier bills for an item addressed in this policy without first receiving
the completed order, the item will be denied as not medically necessary.
A lift, (E0630,E0635,E0636) is covered if transfer between bed and a chair,
wheelchair, or commode requires the assistance of more than one person and,
without the use of a lift, the patient would be bed confined.
An electric lift mechanism is not covered; it is a convenience feature.
When code E0635 or E0636 is billed, if coverage criteria for a patient lift
are met, payment is based on the least costly medically appropriate
alternative, E0630.
Code E0621 is covered as an accessory when ordered as a replacement for the
original equipment item.
A multi-positional patient transfer system (E1035) is covered if both of
the following criteria 1 and 2 are met:
- The criteria
for a lift (E0630) are met; and
- The patient
requires supine positioning for transfers.
If criterion 1 is not met, code E1035 will be denied as not medically
necessary.
If criterion 1 is met but criterion 2 is not met, payment will be made for
the least costly medically appropriate alternative, E0630.
If coverage is provided for code E1035, payment will be discontinued for
any other mobility assistive equipment, including but not limited to:
canes, crutches, walkers, rollabout chairs,
transfer chairs, manual wheelchairs, power-operated vehicles, or power
wheelchairs.
|