“Face to Face Evaluation” Requirement between Physician and Patient
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A Face to Face visit is only required for patients who are requesting a power wheelchair or scooter. Insurance requires that patients have a Face to Face examination by their physician in order to determine if a power mobility device is reasonable and necessary.
Your physician must complete 5 documents to qualify for a power wheelchair.
- A 7-element order.
- Detailed product description.
- Written prescription.
- Progress notes documenting the face to face evaluation (clinical notes).
- A letter of medical necessity.
Who Can Perform the Face to Face Evaluation?
The face to face visit may be done by your primary physician, physician assistant, or a nurse practitioner.
The 7-element prescription must include the following information on the prescription for your power wheelchair or scooter:
- Beneficiary’s name
- Date of Face to Face
- Diagnosis Code (ICD 10)
- Item description: Power Wheelchair, Scooter, or Manual Wheelchair
- Length of Need
- Physician, Nurse Practitioner, or Physician Assistant signature
- Date order form is completed under the signature line
Report of the Face to Face Evaluation should explain why the patient needs a power wheelchair or scooter. The following information is just a guideline.
- The dictated report should include pertinent information regarding the following: Insurance wants a progress note describing the patient’s status and need for equipment.
- Describe the client’s mobility limitation (diagnoses) and how it interferes with your mobility related activities of daily living (MRADLs) in your home. Insurance defines MRADLs as bathing, dressing, feeding, grooming, and/or toileting in customary locations of the home.
- History and physical examination
- Physical examination must focus on functional assessment. Is the patient having difficulty performing MRADLs in standing of from whatever current device they are using?
- Describe past use of cane, walker, manual wheelchair, scooter, or power wheelchair.
- Why can’t a cane, walker, or manual wheelchair meet mobility needs of this patient within the home?
- The physician must document this need even if he/she refers the patient for a PT/OT evaluation.
- The physician must keep in mind that Insurance requires that the device be necessary for mobility inside the home to complete MRADLs. Insurance will not fund equipment that is needed solely for community use.
Time frame for getting documentation to supplier:
- Insurance requires that the face to face progress note (clinical notes) and the written prescription be provided to the supplier within 45 days of the date of the face to face visit. The supplier will request the 7-element order, detailed product description, letter of medical necessity.
- If the physician refers the patient to a PT/OT for evaluation, the 45 day time limit starts from the date the physician signs off on the PT/OT documentation.
- The evaluation by the PT/OT does not take the place of the Face to Face requirement.
Without this information your supplier will not be able to supply you with a power wheelchair or scooter through your insurance.