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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)External PDF
  • 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

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