Noncovered Medical Social Worker Services
The following types of MSW activities are not covered under the Medicare home health benefit:
- Services furnished are of a type directed toward minimizing the problems an illness may create for any beneficiary and family members
- Services furnished are to someone other than the beneficiary except as
stated in the Medicare
Benefit Policy Manual (CMS Pub. 100-02, Ch. 7, § 50.3)
- Preventive counseling, such as financial planning
- The sole purpose of a visit is to assist the beneficiary or significant other to fill out routine forms (e.g., completing advance directives)
- Follow-up visits that do not require a home visit (e.g., arrangements via telephone)
- Routine evaluations at start of care where no problems are documented and no follow-up is necessary (There should be no automatic assessment or routine evaluation.)
- Orders for assessment of social/emotional factors, financial assessment, long-term planning, and counseling, without identifying specific reason or problem to warrant these services
- Services can be handled by a lay person or other disciplines (i.e., if the only documented service is calling Meals on Wheels, this would not be a covered visit, since this call could be placed by any individual)
- Problems are related to a normal stress situation and a normal adjustment period required by any type of illness
Updated: 07.30.12