C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-12, subsec. 144-101-II-12.11

Current through 2024-51, December 18, 2024

Subsection 144-101-II-12.11 - BILLING INSTRUCTIONS

Providers must bill in accordance with the Department's billing instructions for the CMS 1500 that providers receive in their enrollment packages.

ADL = Activities of Daily Living
Activity	Definitions	Time Estimates		Considerations
Bed Mobility	How person moves to and from lying position, turns side to side and positions body while in bed.	5 - 10 minutes		Positioning supports, cognition, pain, disability level.
Transfer	How person moves between surfaces - to/from: bed, chair, wheelchair, standing position (EXCLUDE to/from bath/toilet).	5 - 10 minutes up to 15 minutes		Use of slide board, gait belt, swivel aid, supervision needed, positioning after transfer mechanical lift transfer.
Locomotion	How person moves between locations in his/her room and other areas on same floor. If in wheelchair, self-sufficiency once in chair.	5 - 15 minutes (Document time and number of times done during Plan of Care)		Disability level, type of aids used, pain.
Dressing & Undressing	How person puts on, fastens and takes off all items of street clothing, including donning/removing prosthesis.	20 - 45 minutes		Supervision, disability, cognition, pain, type of clothing, type of prosthesis.
Eating	How person eats and drinks (regardless of skill)	5 minutes		Set up, cut food and place utensils.
		30 minutes		Individual is fed.
		30 minutes		Supervision of activity due to swallowing, chewing, cognition issues.
Toilet Use	How person uses the toilet room (or commode, bedpan, urinal); transfers on/off toilet, cleanses, changes pad, manages ostomy or catheter and adjusts clothes.	5 -15 minutes/use		Bowel, bladder program ostomy regimen, catheter regimen.
Personal Hygiene	How person maintains personal hygiene. (EXCLUDE baths and showers)	20 min/day		Disability level, pain, cognition, adaptive equipment.
	Washing face, hands, perineum, combing hair, shaving and brushing teeth	Shampoo (only if done separately) Nail Care	15 min up to 3 times/week 20 min/week
Walking	How person walks for exercise only How person walks around own room How person walks within home How person walks outside	Document time and number of times in plan of care, and level of assistance needed.		Disability, pain, mode of ambulation (cane), prosthesis needed for walking.
Bathing	How person takes full-body bath/shower, sponge bath (EXCLUDE washing of back, hair), and transfers in/out of tub/shower	15 - 30 minutes		If shower used and shampoo done, then consider as part of activity.
These allowances reflect the time normally allowed to accomplish the listed tasks. The ASA will use these allowances when authorizing a member's authorized plan of care. If these times are not sufficient when considered in light of a member's unique circumstances as identified by the ASA, the ASA may make an adjustment as long as the authorized hours do not exceed limits established for member's level of care. Time authorized has to reflect the possibility of concurrent performance of activities, ex: while wash cycle running, dishes may be washed, floor vacuumed, bathroom cleaned, and other simultaneous activities.