LCD Reference Article Article

Home-Based Fall Evaluations and Interventions

A53055

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A53055
Original ICD-9 Article ID
A50489
Article Title
Home-Based Fall Evaluations and Interventions
Article Type
Article
Original Effective Date
10/01/2015
Revision Effective Date
04/11/2019
Revision Ending Date
N/A
Retirement Date
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AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

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Article Guidance

Article Text

The goal of this article is to provide a framework for the communication of information that both clinicians and Medicare need to make patient-centered decisions.

Services provided by HHAs under the 32x bill type are reimbursed under the Home Health Prospective Payment System (HH PPS), while those delivered under the 34x bill type are reimbursed as Part B Outpatient Rehabilitation Services. Part B Outpatient Rehabilitation Services (with the exception of those furnished by or under arrangements with a hospital) are subject to the financial limitations described in the CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 5, Section 10.2.

This article underscores the importance of a comprehensive evaluation of the circumstances surrounding the documented fall event(s). It is important that a comprehensive examination and evaluation including a detailed history as well as neurological/sensory, musculoskeletal, and vascular/cardiopulmonary systems reviews be documented. Palmetto GBA is addressing this need through an approach called Going Beyond Diagnosis® (GBD). GBD promotes use of the International Classification of Functioning Disability and Health (ICF) to capture and organize the information necessary to support the clinical and administrative needs of HHAs performing home-based fall evaluations and interventions.

Response To Comments

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Coding Information

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
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ICD-10-CM Codes that are Covered

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ICD-10-CM Codes that are Not Covered

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Revenue Codes

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Other Coding Information

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
04/11/2019 R7

Under Article Text deleted the first paragraph, deleted the first sentence in the second paragraph and added verbiage “The goal of this article is to provide a framework for the communication of information that both clinicians and Medicare need to make patient-centered decisions”, deleted “This LCD” from the first sentence in the third paragraph and added “This article”, deleted “agrees with this observation and” from the third sentence in the third paragraph, and deleted the fourth paragraph.

01/25/2018 R6

Annual validation with no revisions made.

04/07/2016 R5 Under Article Text added the following verbiage to the second paragraph: CMS Internet-Only Manual, Pub. 100-04 and deleted the hyperlink to the Medicare Claims Processing Manual. Under CMS Manual Explanations URLs deleted the hyperlink to the Medicare Claims Processing Manual.
02/11/2016 R4 Under Article Text in the last sentence of the first paragraph added "s" to therapist. In the first sentence of the second paragraph deleted the "s" from LCDs.
06/11/2015 R3 Per CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.3 LCDs consist of only “reasonable and necessary” information. All bill type and revenue codes have been removed from the LCDs. For consistency, they are also being removed from the articles.
10/01/2015 R2 Removed 033x Bill Type as per Change request 8244.
10/01/2015 R1 Added CMS Manual Citation to Associated Documents. Corrected Hyper-links in Article Text.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
04/04/2019 04/11/2019 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Fall