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Medicare Evaluations/Reevaluations FAQs See our Medicare Evaluations and Medicare Re-evaluations sections for more detailed guidance. |
Who can perform a therapy evaluation?
Only a clinician may perform an initial examination, evaluation, re-evaluation and assessment or establish a diagnosis or a plan of care.
A clinician means either a physician or a physical, occupational, or speech therapist.
When does an evaluation need to be performed?
An evaluation must be completed prior to beginning of treatment.
Can an evaluation and treatment be performed on the same visit?
Yes. Once the evaluation has been completed, the therapist may start treatment.
What must be included in the evaluation?
A diagnosis (where allowed by state and local law) and description of the specific problem(s) to be evaluated and/or treated.
Results of one of the following four measurement instruments are recommended, but not required:
Documentation supporting illness severity or complexity.
Documentation supporting medical care prior to the current episode.
Documentation required to indicate beneficiary health related to quality of life.
Documentation required to indicate beneficiary social support.
Documentation required to indicate objective, measurable beneficiary physical function.
References
Medicare Benefit Policy Manual Ch. 15 – Covered Medical and Other Health Services §220.3
Billing and Coding: Outpatient Physical and Occupational Therapy Services: A57067
Billing and Coding: Therapy Evaluation, Re-Evaluation and Formal Testing: A52773
Outpatient Physical and Occupational Therapy Services: L34049
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About Us Zachary Edgar JD, LLM is the managing partner for Therapy Comply. Zachary is a healthcare attorney that specializes in federal and state healthcare regulatory issues particularly for physical, occupational, and speech therapy practices. | Join Us Join today as a yearly member and enjoy full access to the site and a significant discount to our live and recorded webinars. Members also have access to compliance and billing support. |