In-home safety assessments, Medicare
Priority Health Medicare Advantage plans
An in-home safety assessment is designed to help reduce safety hazards and the risk of falls in the home. It is performed by an occupational therapist or other qualified health provider.
In-home safety assessment coverage
Priority Health offers this supplemental benefit for Medicare Part C (Medicare Advantage) plan members who do not qualify for this service under Original Medicare's home health benefit.
This benefit is listed in the Medicare Managed Care manual, Chapter 4, sections 30.1, 30.2, 30.3, & 90.5. It's included in the Evidence of Coverage (EOC) documents for all of our Medicare Advantage plans. The EOC is the contract for covered services between the member and Priority Health.
Minimum requirements: The minimum requirements for the assessment are included in our In-home Safety Assessment form. However, you may use a form you have in your EMR that includes the minimum requirements.
These conditions must be met for the service to be covered:
The assessment must focus on the patient's risk for falls or injuries and identification of how falls may be prevented.
If bathroom safety devices are installed, they should be:
- Appropriate for the individual beneficiary's home
- Determined by the occupational therapist or other qualified health provider furnishing the safety assessment to be necessary to prevent injury, and
- Approved by the beneficiary.
The assessment may include identification and/or minor modification of some home hazards outside of the bathroom, in order to reduce risk of injury. Such modifications may include removal of rugs that are not attached to the floor and rearrangement of furniture to create clear pathways.
In-home safety assessment billing
Coding: Bill revenue code 0583 with HCPCS T1028.