Documentation requirements
These include medical conditions for acute and occasionally chronic conditions that have supporting documentation that the extra sessions are reasonable and necessary (e.g., through documents from recent hospital care, office visits, dialysis progress notes or MCP visits).
Please note that the POC and other supporting medical documentation to justify any of the line item sessions will be most important and may be requested.
A denial will occur on these lines, but the redetermination process (an appeal) will be available to submit supportive documentation for review.
Please see L35014 for Documentation Requirements and Utilization Guidelines.
Title XVIII of the Social Security Act, Section 1833(e) requires that there has been furnished such information as may be necessary in order to determine the amounts due.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 90999 | HCPCS | Covered |
| E83.30 | ICD10CM | Covered |
| E83.39 | ICD10CM | Covered |
| E87.21 | ICD10CM | Covered |
| E87.22 | ICD10CM | Covered |
| E87.29 | ICD10CM | Covered |
| E87.5 | ICD10CM | Covered |
| E87.70 | ICD10CM | Covered |
| E87.71 | ICD10CM | Covered |
| E87.79 | ICD10CM | Covered |
| I30.0 | ICD10CM | Covered |
| I30.1 | ICD10CM | Covered |
| I30.8 | ICD10CM | Covered |
| I30.9 | ICD10CM |