Writing a letter of medical necessity
Writing a Letter of Medical Necessity A letter of medical necessity (LMN) is a detailed prescription a clinician writes and is submitted to the funding source. The letter should be consumer specific, not just a list of the medical benefits of standing. Documentation must communicate the process that was followed, the options that were considered, and the medical necessity for the requested equipment. The documentation should include all of the following:
1. A detailed letter of medical necessity (LMN) contains:
- Writer’s expert credentials
- Consumer’s name, date of birth, weight and height
- History and physical exam by clinician including summary of medical condition, diagnosis/onset, prognosis, and co-morbid conditions
- Functional and physical assessment including, but not limited to, strength, range of motion, tone, sensation, balance, ADLs, IADLs, and functional status
- Documentation of other devices considered, and why each was ineffective for the consumer
- Documentation of trialed device(s) and outcomes of the trial (s)
- Justification of the model of device being recommended as well as each option and accessory required for the consumer
- Evidence that the consumer demonstrated the ability to safely use the device independently or with appropriate assistance
- Outline of the prescribed standing program recommendations
- Any applicable research to support intended outcomes
2. A prescription for the device from the consumer’s physician
- WriteThis is typically a co-signature on the LMN stating the physician agrees with the prescribed device. All appropriate medical professionals involved in the consumer’s care, as it relates to standing should also co-sign the LMN or provide additional documentation to support need. Examples include: Physiatry (Rehabilitation Medicine), Neurology, Orthopedics, Cardiology, Urology, Primary Care, Occupational Therapy, Physical Therapy, Speech Language Pathology, Psychology, etc.