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Letter of Medical Necessity for Gait Trainers and Standers

Lindsey Veety, PT, DPT, ATP/SMS

February 1, 2023

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Question

What should be included in a letter of medical necessity for a gait trainer or stander?  

Answer

It is first important to make sure that you know your funding sources and what your funding sources cover. I can't say that enough to people and I feel it is important to cover what is meant by least costly alternatives. It's a provision in the health insurance policy that states that they will cover the least expensive device when multiple options are possible. You need to follow the flow of appropriate devices which is what they call it. If there are multiple similar items of the same type of device (gait trainers or standers), as the therapist you need to determine what features the client needs and you need to try the least costly alternative first. You need to rule out why that does not medically meet their needs if it does not meet their needs.  it is my responsibility to have the conversation with the patient/parents to say, well, this is the least costly alternative. This is the one that your insurance company is going to cover. If you want to pay for this one out of pocket because you like it better, you can do that. That can be a tough conversation sometimes, but if there's a reason, by all means, we justify it. For example, this one has a headrest, but this one doesn't; this one goes taller and this one doesn't. We need this one to be wider, this one isn't wide. If there's a reason, list it and you're golden. But, if there truly is no reason and A and B provide the same support and it really just is that somebody likes A better, but A is more expensive than B, my hands are tied, the vendors' hands are tied, this really is what the insurance company is going to pay for. 

For the letter of medical necessity you need to include the following: 

  • Least costly and safest as mention
  •  Justify each support as needed
    • Example: “In addition to improving ambulation skills to perform Activities of Daily Living, and providing an opportunity for exercise, the recommended ______gait trainer has numerous essential health benefits as well as providing support for Alex in standing to maintain his joint, muscle as he presents with bilateral tight hamstrings, bone and skin health.” 
  • State trials and success for equipment
  • State why it is MEDICALLY necessary- just as you would in a wheelchair justification
  • If the piece of equipment requested is not the least costly, clearly state why it is needed.
    • This one has more supports
    • Size
    •  Why others would not be safe. 

Try to avoid check box template forms or impersonalized form letters, especially manufacturer generated.

Critical to personalize each request to the individual and to what the insurance company requires. 

It is the job of the writer to clearly convey a story or “paint a picture” to the reviewer. They should be able to clearly visualize who the person is, what they need, and why by the end of your letter.

This Ask the Expert is an edited excerpt from the course, Standers and Gait Trainers 101 presented by Lindsey Veety, PT, DPT, ATP/SMS


lindsey veety

Lindsey Veety, PT, DPT, ATP/SMS

Lindsey is a Physical Therapist with 20 years of experience, who specializes in working with individuals with complex conditions and assistive technology. She is a RESNA-certified ATP/SMS and has completed her (Neuro-Developmental Treatment )NDT training. Lindsey specializes in the areas of seating and positioning, custom-molded seating, and adaptations/access to the environment. She enjoys presenting at conferences, doing webinars, and publishing in these areas as well.


Related Courses

Writing Letters of Medical Necessity for Seating and Wheelchairs
Presented by Lindsey Veety, PT, DPT, ATP/SMS
Recorded Webinar

Presenter

Lindsey Veety, PT, DPT, ATP/SMS
Course: #4424Level: Intermediate2 Hours
  'Instructor’s teaching style and content knowledge'   Read Reviews
This course covers the details of what to include in a letter of medical necessity. Examples are given along the way to support different types of chairs and seating and different scenarios for when insurance companies ask for information.

Pediatric Specialty Beds
Presented by Lindsey Veety, PT, DPT, ATP/SMS
Recorded Webinar

Presenter

Lindsey Veety, PT, DPT, ATP/SMS
Course: #4734Level: Introductory1 Hour
  'Never thought of this for my parents who deal with hard to sleep children'   Read Reviews
Sleep is vital for the proper health of the individual and their caregiver. A specialty bed may be the solution when a typical bed does not meet an individual's needs due to positioning or safety reasons. This presentation introduces what specialty beds are, what different patient populations they would be best used for, compares and contrasts what beds are available, their features and functions, and tips for assisting with funding.

Standers and Gait Trainers 101
Presented by Lindsey Veety, PT, DPT, ATP/SMS
Recorded Webinar

Presenter

Lindsey Veety, PT, DPT, ATP/SMS
Course: #4519Level: Introductory2 Hours
  'I could tell that the presenter was a practitioner with real-life experience using each device with individual patients, rather than just teaching about it'   Read Reviews
When an individual needs assistance with standing or ambulating, knowing which system or supports to choose can be difficult, as there are currently many different options on the market. This presentation introduces the clinician to adapted standing and gait training systems, including who they would be best used for, compare and contrast the leading systems on the market, and funding options.

Pediatric Special Needs Car Seats and Adapted Strollers
Presented by Lindsey Veety, PT, DPT, ATP/SMS
Recorded Webinar

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Lindsey Veety, PT, DPT, ATP/SMS
Course: #4735Level: Introductory1 Hour
  'Nice overview of what is currently available'   Read Reviews
Transportation options for individuals with disabilities have expanded tremendously, giving families many more options to safely, easily and quickly move between locations. This presentation will give an introduction to what adapted car seats and strollers are, how to evaluate, tips for selecting the optimal product for your client and funding options.

Custom Molded Seating 101
Presented by Lindsey Veety, PT, DPT, ATP/SMS
Recorded Webinar

Presenter

Lindsey Veety, PT, DPT, ATP/SMS
Course: #4315Level: Introductory2 Hours
  'great to see different options for my patients'   Read Reviews
When seeing a client in a wheelchair, knowing what type of seating to choose can be a challenge, especially if the client presents with complex conditions or body shapes that don't fit into linear seating. This presentation will give an introduction to what custom molded seating is, who it would be used for, compare and contrasting the main custom molded seating systems on the market, and go through a simulated molding, fitting, and delivery. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

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