Insurance Coverage Procedures for STAT MEDICAL Personal Emergency GPS Safety Device
We always recommend contacting your primary insurance company or state Medicaid Program office to find out exactly what they cover and what documentation they require. This is just a basic outline of what is typically required.
- Using the list of codes provided, obtain a prescription from the
- Request a quote directly from Stat Medical.
- Submit prescription and quote to either your case/ social worker or directly to your insurance company to make sure they will cover the Medical Alert device you have chosen.
***For individuals enrolled in Medicaid waiver programs, please contact us at 732-508-7800 to see if we are already on their authorized durable medical equipment provider list.
If you have any general questions, please send an email to email@example.com or go to the contact page at www.statmedicalalert.net
Please remember we are unable to bill Medicaid or your private insurance directly and therefore you are responsible for payment and submission of the paperwork required for reimbursement.
These devices are confirmed to be covered by: Kaiser Permanente, United Healthcare, Transatlantic Insurance, American Maritime Officers, and Select Health to name a few.
The concept of wandering was added to ICD-9CM effective with the October 1, 2000 update as an inclusion term under at code 294.11.
Prescription from Doctor: A prescription from your Physician needs to be requested and including the following information:
Name: Exact name of the Medical Alert Device you have chosen for Wandering Prevention.
Example; MX-LOCare GPS Watch, AngelSense, Bell +, LOK8U.
Alzheimer’s Disease (331.0)
Autism or Pervasive Development Disorder PDD (299.0-299.9)
Dementia, unspecified, with behavioral disturbance (294.21)
Intellectual disabilities (317-319)
Sub code: (See above) Wandering Code: V40.31
HCPCs: S5162 – Billing Code for Purchase
Submit this to the insurance company or state funded program with a receipt for your purchase.
Additional Codes (if needed)
Other: If denied – Use Enhanced Medical Assistive technology
CPT Codes – X is HIPAA compliant code S is CPT or HCPCs code
X5012 Personal emergency response system S5160, S5161, S5162
S5160: Emergency response system; installation and testing S5161:
Emergency response system; service fee, per month (Excludes installation and testing)
S5162: Emergency response system; purchase only X5014 DME – personal emergency response system, Installation
The new HCPCs codes level 2 are for items not covered in level 1 coding. Try these new codes HSW is Health, Safety, & Welfare
HCPCs Code – S5160K
Units of Service – Maximum allowed based on 12 month plan
Personal Emergency Response System – install/test (HSW Only)
HCPCs Code – S5161HK Per Month
Unit of Event Personal Emergency Response System – monthly service fee (HSW only) S5161HK Per Month
HCPCs 2017 Code – E1399 Durable Medical Equipment, miscellaneous
Please feel free to contact us is you have any questions or feel you require further assistance.
PHYSICIAN SAMPLE LETTER: AUTISM ELOPEMENT (Can be used for Alzheimer’s, dementia or any other cognitive impairment)
NAME OF CHILD OR ADULT (DOB XX/XX/XX) carries a diagnosis , which poses certain cognitive challenges and safety risks. NAME currently attends NAME OF SCHOOL in NAME OF TOWN. If this is for an adult you can leave this part out.
NAME has a history of wandering from safe environments, including a YEAR incident where NAME wandered from LIST INCIDENT. According to Centers for Disease Control (CDC), Wandering places children and adults with autism spectrum disorders (ASDs) in harmful and potentially life-threatening situations—making this an important safety issue for individuals affected and their families and caregivers.
If given the opportunity, NAME will wander from safe environments. NAME’S wandering tendencies include goal-directed elopement, which means NAME will seek out items of interest, specifically roads and bodies of water. NAME’S history also includes fleeing incidents following a meltdown or escalation trigger.
It is for these reasons, and NAME’S history of elopement, that NAME now has a medical diagnosis of Wandering In Diseases Classified Elsewhere (ICD-10-CM Diagnosis Code Z91.83). To ensure NAME’s safety, it is medically necessary that NAME have close and constant adult supervision at all times, and that proper safeguards are in place. Safeguards may include architectural barriers, door alarms, visual prompts, and a school-wide response protocol.
A Functional Behavioral Assessment should be done to help identify root causes of NAME’s elopement behaviors. NAME must never be left unattended by any adult for any reason. Leaving NAME unattended poses serious safety and health risks.
For more information on the wandering diagnostic code, visit http://www.cdc.gov/ncbddd/autism/code.html