Gov't affairs

Wednesday, April 30, 2008

Q. When do I need a therapist evaluation for a power wheelchair?

A. An evaluation by a PT or OT, also referred to as a licensed certified medical professional (LCMP), is specifically required by Medicare policy anytime a client receives a Group 2 single power option or multiple power option power wheelchair (PWC), any Group 3 or Group 4 PWC, or a push rim activated power assist device for a manual wheelchair. A physician that specializes in PWCs may also perform this evaluation in lieu of an LCMP. This evaluation is a separate requirement from the face-to-face exam that must be performed by the prescribing healthcare professional.
Having said that, as far as documentation is concerned, a PT or OT assessment is never a bad thing to have in your client's file for any type of mobility assistive equipment. These assessments often provide the most details about a client's abilities and limitations, and often contain the quantitative measurements that Medicare likes to see. For example, a clinical measurement such as 4/5 tells us the patient has full range of motion with some resistance.
An LCMP evaluation can be a valuable part of a patient's medical record. There are a few caveats to keep in mind. Most importantly is the fact that for the LCMP evaluation to be considered part of the medical record, the LCMP must not have any financial relationship with the DME provider. Also, an LCMP evaluation is not separately payable for patients who are receiving home health benefits. Having said that, LCMP evaluations can often provide those details Medicare looks for more when moving through the MAE algorithm. HME