AOTA Advocacy Success: Medicare Contractor Reverses Noncoverage Policy for Assistive Technology Code
Medicare Contractor, First Coast Service Options, Inc. informed AOTA that in light of AOTA’s reconsideration request, First Coast is revising its coverage policy for assistive technology to include the assistive technology CPT code 97755 as a covered service.
First Coast is the Medicare Administrative Contractor for Florida, Puerto Rico, and the U.S. Virgin Islands. First Coast’s current policy—local coverage determination (LCD)—lists the assistive technology code as a noncovered service for occupational therapy. AOTA submitted a reconsideration request asking First Coast to remove the code from the list of noncovered services and add it to the Therapy and Rehabilitation Services LCD as a covered service.
AOTA's reconsideration request argued that CPT code 97755 is an "essential code for those beneficiaries with severe conditions, such as spinal cord injuries, that require a sophisticated assessment of available technology, the patient’s abilities, and his/her environment in order to assure the best “fit” for optimal functioning." To provide examples of individuals that require assistive technology assessment, AOTA member Cindi Petito, OTR/L, ATP, CAPS, assisted AOTA by creating case scenarios to file with our request.
First Coast notified AOTA that, “it has been determined that this LCD be revised to remove this CPT code from the ‘CPT/HCPCS Codes’, ‘Local Noncoverage Decisions, Procedures’ section of the LCD. In addition, LCD THERSVCS: Therapy and Rehabilitation Services will be revised to add CPT code 97755.”
First Coast has issued revised LCDs to reflect its decision to cover CPT code 97755 as a result of AOTA’s reconsideration request. The new coverage policies were effective August 11, 2009:
LCD for The List of Medicare Noncovered Services (L29288)
LCD for Therapy and Rehabilitation Services (L29289)