Cornerstone Medical Services

• Patient must have a medical condition which requires positioning in the body in ways not feasible with ordinary bed
• Patient requires head of the bed to be elevated more than 30 degrees most of time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration.

• Patient is confined to a single room
• Patient is confined to one level of home and there is no toilet on that level
• Patient is confined to home & there are no toilets in home.

• Prescription in Mother's name with a qualifying lactating diagnosis

• Documentation showing that mobility is limited from the patient accomplishing the MRADL entirely
• Places the patient area determined heightened risk or mortality to perform the MRADL
• Preventing the MRADL within a reasonable time frame.

• Diagnosis must be total knee manipulation

• Documentation showing that mobility is limited from the patient accomplishing the MRADL entirely
• Places the patient area determined heightened risk or mortality to perform the MRADL
• Preventing the MRADL within a reasonable time frame.

• Clinical documentation required to support the need for specialized formula
• Justification is needed for pumps versus gravity or syringe
• Following items must be included, Home Health Agency, type of tube & size, allergies, written orders, discharge summary, progress notes, medication listing, nutrition assessment notes, nutrition support team notes

Are covered when patient has one of the following:

• 011.50-011.56 - Tuberculous Bronchiectasis unspecificed
• 042 - Human Immunodeficiency Virus (HIV Disease)
• 136.3 - Pneumocystosis
• 277.02 - Cystic Fibrosis with Pulmonary Manifestations
• 480.0 - 508.9 - Pneuomonia due to Adenovirus - Respiratory conditions due to unspecified external agent
• 786.4 - Abnormal Sputum
• 996.80 - 996.89

• Detailed Written Order is needed
• Wound notes describing type of wound, measurement (stage III or IV), alternate therapies tried, nutritional support

• Documented testing at rest without oxygen at or above 89%
• Testing during exercise without oxygen
• Testing during exercise with oxygen applied to demonstrate the improvements of the hypoxemia

• Mobility limitation cannot be sufficiently resolved by the use of fitted cane or walker
• Beneficiary's home provides adequate access between rooms, maneuvering space, and surfaces for use of the manual wheelchair
• Use of manual wheelchair will significantly improve the beneficiary's ability to participate in MRADLS and the beneficiary will use it on a regular basis in the home.
• The beneficiary has not expressed an unwillingness to use the manual wheelchair that is provided in home.

• Documentation showing that mobility is limited from the patient accomplishing the MRADL entirely
• Places the patient area determined heightened risk or mortality to perform the MRADL
• Preventing the MRADL within a reasonable time frame.