Medicare Home Medical Equipment Qualifications

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The elements that are addressed will depend on the diagnoses that are responsible for the mobility deficit.  For example, for patients with COPD, heart failure, or arthritis, the major emphasis will be on symptoms and history of the progression of their condition rather than on the physical examination.  Functional assessment is important for all patients. Physicians shall also provide reports of pertinent laboratory tests, x-rays, and/or other diagnostic tests (e.g., pulmonary function tests, cardiac stress test, electromyogram, etc.) performed in the course of management of the patient. Physicians shall document the evaluation in a detailed narrative note in their charts in the format that they use for other entries.  The note must clearly indicate that a major reason for the visit was a mobility evaluation.  Physician Fee for Face-To-Face evaluation Due to the MMA requirement that the physician or treating practitioner create a written prescription and a regulatory requirement that the physician or treating practitioner prepare pertinent parts of the medical record for submission to the durable medical equipment supplier, the Centers for Medicare & Medicaid Services (CMS) has established the new G Code (G0372) to recognize additional physician services and resources required to establish and document the need for a PMD. CMS believes that the typical amount of additional physician services and resources involved is equivalent to the physician fee schedule relative values established for a level 1 office visit for an established patient (Current Procedural Terminology (CPT) code 99211). The payment amount for such a visit is $21.60 Code G0372 indicates that: – All of the information necessary to document the PMD prescription is included in the medical record. – The prescription, along with the supporting documentation, has been received by the PMD supplier within 45 days after the face-to-face examination. Effective October 25, 2005, G0372, will be used to recognize additional physician services and resources required to establish and document the need for the PMD, and are  added to the Medicare physician fee schedule.
Source: viennamedical.com

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