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OhioBWC - Basics: (Policy library) - File

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In-Home Physician Visits and Physician Mobile Office Visits

In-home physician visits (services) require prior authorization after the first visit; however, the first and following visits must meet the Miller Criteria.

 

In-home physician visits may be appropriate and should be approved only when the injured worker is homebound and is unable to access outpatient facilities because of sensory impairment, immobility or transportation problems due to physical limitations. Examples might include injured workers with catastrophic conditions or those requiring end of life care. Lack of transportation does not constitute a medical reason for approving in-home physician visits.

 

Prior approval shall be granted by the MCO according to the plan of care and health care needs for the specific injured worker. Reimbursement to physicians will be made using Current Procedural Terminology (CPT) codes for Home Visits and the level of code must reflect current coding documentation standards for the CPT level of service. Services rendered must only be those services indicated by the circumstances that are medically necessary.

 

Mobile van or trailer physician visits or services, when the injured worker walks to the van or trailer, will be reimbursed as a normal office visit according to CPT levels of service and will not be eligible for billing as a home visit.   Mobile offices must bill using the appropriate office or other outpatient services CPT evaluation and management code, with place of service 15 (mobile unit) and will be reimbursed at BWC’s Non- Facility Fee.

 

If a physician chooses to make a home visit to an injured worker who does not meet the criteria for a home visit or when determined by the MCO/BWC not to be medically necessary, the physician may not bill the services as a home visit.  If the services are considered medically appropriate and necessary if delivered in a customary office setting, the physician must bill using the appropriate office or other outpatient services CPT evaluation and management code, with place of service 12 (home) and will be reimbursed at BWC’s Facility Fee. 

 


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