Superseded Local Coverage Article

Therapy Driving Evaluations


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Contractor Information

Article Information

General Information

Article ID
Original ICD-9 Article ID
Article Title
Therapy Driving Evaluations
Article Type
Original Effective Date
Revision Effective Date
Revision Ending Date
Retirement Date
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Article Guidance

Article Text
Medicare does not reimburse evaluations performed solely to assess a beneficiary's ability to drive a vehicle. In order for a service to be covered, the service must have a benefit category in the statute Title 18 of the Social Security Act (SSA), it must not be excluded, and it must be reasonable and necessary. There is no benefit category for driving evaluations.

In addition, both screening (except as specifically exempted by statute) and routine physical examinations are excluded from coverage. 42 United States Code (USC) 1395y (a) describes routine physical checkups as:

1. Examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptom, complaint, or injury.
2. Examinations required by insurance companies, business establishments, government agencies or other third parties.

For Medicare purposes, when services provided are related solely to driving, they are not reasonable or necessary for the diagnosis or treatment of an illness or injury and are excluded from coverage under the program by SSA 1862(a)(1).

This is a statutory exclusion. The beneficiary is liable for the charges and no Advance Beneficiary Notice of Noncoverage (ABN) is required. However, providers are encouraged to provide a voluntary ABN. Append modifier GX (Notice of Liability Issue, Voluntary under Payer Policy) to any billed line item.


• CMS Internet Only Manual (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 1 Section 60
• Social Security Act (SSA) Sections 1861 and 1862(a)(1)
• 42CFR 411.15(a)

Coding Information

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.


Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.




ICD-10-CM Codes that are Covered


ICD-10-CM Codes that are Not Covered


Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2015 R1 The wording and/or formatting in this article was changed.

Associated Documents

Related Local Coverage Documents
Related National Coverage Documents
Statutory Requirements URLs
Rules and Regulations URLs
CMS Manual Explanations URLs
Other URLs
Public Versions
Updated On Effective Dates Status
09/29/2020 10/01/2015 - N/A Currently in Effect View
07/09/2014 10/01/2015 - N/A Superseded You are here
03/31/2014 10/01/2015 - N/A Superseded View