Lots of good questions. I'll answer to the best of my ability:
JT> I read somewhere that we needed some type of credentials
At one time, Medicare was going to require that all w/c evals be
done only by people holding an ATP credential. This never came
to fruition, so no special credential is currently required.
JT> NMy second question is how do you bill medicare for this?
I bill Medicare under the CPT code 97542 <W/C Management>. This
is a timed codes so billing in accordance with all time code
requirements, e.g. 7-minute rule, face to face, etc.
There is no specific time allowed for the eval. Each eval is
different and requires a different time. Usually, 30 minutes to
an hour is what is required. Higher level evals take longer!
Do not bill under OT eval, as this is NOT appropriate. An OT
eval is used to generate a plan of care and you will not be
doing that.
JT> Do we need a doctors order to do this evaluation?
Medicare does NOT require doctor's orders for any therapy. The
requirement is that the patient be under the care of a doctor.
This requirement is met when a doctor signs your w/c evaluation.
You may obtain an order if desired and/or required by your
state, but it's NOT required by Medicare. But, the patient MUST
be under a doctor's care. You will need the MD's information for
billing purposes.
For the record, I do NOT write a separate letter of justification. That
information is contained in my evaluation.
Hope this helps.
Ron
~~~
Ron Carson MHS, OT
www.OTnow.com
----- Original Message -----
From: Juan Turcios <[email protected]>
Sent: Wednesday, June 10, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] W/C evals
JT> Hello all, I have more medicare questions for you. Are there any
JT> requirements that we (OT's) must have to perform w/c evaluations? I read
JT> somewhere that we needed some type of credentials. When I use to do the
JT> evals (more than 8yrs ago) I remember that I spent about 45-60 minutes doing
JT> the measurements and about an hour writing the letter of justification. My
JT> second question is how do you bill medicare for this? and what is the
JT> billable time allotted for these type of evaluations? Do we get the hour
JT> only and bill under OT evaluation. Do we need a doctors order to do this
JT> evaluation? or we can do the evaluation without the other, but we need
JT> it for w/c training? Thanks again Juan Turcios
JT> --
JT> Options?
JT> www.otnow.com/mailman/options/otlist_otnow.com
JT> Archive?
JT> www.mail-archive.com/[email protected]
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