‘Letter of Medical Necessity’ Example for Occupational Therapy
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Writing an effective letter of medical necessity is one of the many skills an occupational therapist (OT) will need to have. This “letter of medical necessity” example can be used as a template.
The purpose of these letters is to make sure your clients receive the tools and services they need to achieve their occupational therapy goals.
This article explains what a letter of medical necessity is, the reasons why an OT would need to write one, and it also provides a “letter of medical necessity” example.
What is a letter of medical necessity (LMN)?
A letter of medical necessity (LMN) is essentially a letter written by a licensed medical professional to describe the need for supplies, equipment, or services to support a patient in their treatment.
You can download a letter of medical necessity template for occupational therapists in this article to use in your practice.
There are many reasons a patient may need an LMN, but the main reason is to seek reimbursement from entities such as insurance companies or a client’s health savings account (HSA).
An LMN is used to explain why a certain supply, piece of equipment, or treatment is being recommended as part of a client’s overall medical treatment. The letter proves that the equipment or treatments you’ve requested funds or reimbursement for are medically necessary or valid methods to meet treatment goals and objectives.
If your client has an HSA or flexible spending account (FSA), the LMN can be used to seek reimbursement through these accounts. An LMN can also support your client’s claim of an eligible medical expense by the Internal Revenue Service (IRS).
Reasons an OT may need to write a letter of medical necessity
There are many reasons an OT may need to write an LMN, such as:
- You may need equipment or supplies to treat your patient that aren’t covered by insurance, but will be covered when the insurance company receives a letter of medical necessity
- Medicare and Medicaid may require them—even for covered services
- The IRS may ask for the letter if your client is trying to write off equipment or supplies on their taxes
LMNs are written as justification for equipment or services. They can be written so your client can get a specific piece of equipment covered by their insurance or in support of an insurance claim that was previously denied.
Some healthcare settings may have regulatory compliance protocols that necessitate the letters due to services being audited or subject to oversight.
Some examples of services, treatments, or products that might require a letter of medical necessity can include:
- Yoga
- Medical equipment such as a hospital bed
- A wheelchair or other seating options
- Exercise equipment
- Baby formula
- Health and fitness tracker
- Massage equipment
- Homeopathic or naturopathic services or medicines
At the end of this article, you can copy and download a “letter of medical necessity” example to use and save in your EHR for occupational therapists.
What to include
It’s important to include the following information in your letter of medical necessity:
- Basic information, including the date, name of the client, their date of birth, your name, your signature, your credentials, your company name, etc.
- An introduction detailing the name of your client and the equipment or device you’re requesting
- The duration of your client’s treatment
- Treatment recommendations and rationale
- Your client’s medical history, emphasizing health conditions, diagnoses, and/or surgeries relevant to the medical equipment or device you’re requesting
- Your current concerns regarding deficits you’ve observed due to your client’s medical history, health conditions, or diagnosis
- An explanation of what will happen if the client does not receive the requested medical equipment or device
- Specifics about your equipment or device recommendation, including the brand, model, and any features you are requesting for the specific medical device or item
- If you’re recommending any add-ons or specific features, make sure to include the rationale for those add-on features
- A closing sentence with your contact information in case your client’s doctor or insurance company needs to follow up with you
Other information you may need to include:
- A description of all treatments, including previous failed treatments
- A summary of your evaluation
- A copy of your clinical notes
- A copy of your client’s medical records
- Supporting literature for the use of the medical equipment you are requesting
- Diagnostic test results
- A description of patient compliance
- Success rates when using the equipment being requested
Although every insurance company has different requirements—and writing this letter of medical necessity won’t guarantee your request will be approved—including these sections might increase the chances of your client’s insurance covering the item or medical equipment you have requested.
Many insurance companies have their own OT sample letter of medical necessity, or “letter of medical necessity” examples. Be sure to check the website of your client’s insurance company for specific information on what their insurance requires.
You can contact your client’s insurance company before you write your letter and ask them to provide you with definitions of medical necessity to help guide what needs to go in your letter.
Knowing the specific information required from your client’s insurance company will help you write your letter, save you time, and increase the chance that your request will be approved.
Use this SimplePractice “letter of medical necessity” example to help you write a letter that justifies your request.
Medicare requires a certificate of medical necessity. They have their own template (such as this “letter of medical necessity” example) that you will need to fill out. However, Medicare has different templates for each diagnosis, so be sure to fill out the correct form.
Many websites also have “letter of medical necessity” examples that can help guide you. Make sure to visit the website of both the insurance company AND the website for the equipment you want to order.
As OTs, we have the skills and knowledge to advocate for our clients and help get them the equipment or supplies they need to support their recovery. Writing a letter to get our prescribed treatments financially covered is just one of many ways we help support our clients.
READ NEXT: How to Start an Occupational Therapy Private Practice
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