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Does Medicare Cover Home Safety Assessments

Summary: Medicare will cover home safety assessments if they are considered medically necessary by a Medicare-approved physician due to a recent preventable injury at home or if it is required for durable medical equipment installation. Estimated Read Time: 8 min

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Table of Contents

    1. Why A Medicare Home Safety Assessment May Be Medically Necessary
    2. Medicare Home Safety Assessment Categories
    3. How to Get Medicare Coverage for a Home Safety Assessment

As you age, it becomes more and more important to ensure that the home you are living in is a safe environment. Unfortunately, injuries in the home are common, and a large percentage of seniors each year become hospitalized due to injuries at home that could have been prevented with regular home maintenance and upkeep.
Thankfully, there are resources available to you through Medicare to help avoid these situations. Your Medicare benefits will cover home safety assessments when ordered through your primary care physician.
A home health care agency will come to your home and provide a thorough inspection to ensure you home is passing safety codes and needs no renovations to keep you safe. The home health care agency will then bill the service to Medicare.

Why A Medicare Home Safety Assessment May Be Medically Necessary

A home safety assessment may be considered medically necessary by your physician if you have recently experienced an avoidable injury in your home. In this case, a licensed professional home inspector will come into your home to help identify potential safety hazards.

During a home safety assessment, both the interior and exterior of your home will be inspected, ensuring you are safe all around. A few examples of home safety assessment recommendations include:

      •     Decluttering in order to provide an accessible path for first responders
      •     Securing rugs or loose carpeting
      •     Fixing broken floorboards or stairs
      •     Ensure your home has working smoke and carbon monoxide detectors
      •     Keeping everyday items off of high shelves and in easy reach
      •     Equipping your bathroom with handrails
      •     Ensure no siding is lose or shingles are missing from the exterior of your home

Once a home safety assessment is preformed, the inspector will provide you with a detailed list of recommendations to help secure your home for years to come.

Medicare Home Safety Assessment Categories

During your home safety assessment, the assessor will observe and discuss with you the following issues as they are relevant to the overall safety of your home.

Categories to assess during a home safety assessment:

      • Assessing the structure of your home
      • Fall Risk Assessment
      • Fire Hazzard Assessment
      • Electrical Safety Assessment

Assessing the Structure of Your Home

Assessing the structure of your home is important, especially if you plan to reside in your home for the remainder of your life. The intention of this inspection is to confirm the floor, foundation, and walls are solid with no potential for cracks, holes, or sinkage. This could cause an unsteady base of your home causing you to lose balance and fall.

Throughout the U.S, more than 36 million falls are reported among older adults annually resulting in more than 32,000 deaths. By utilizing a Medicare home safety assessment and fixing these issues, this statistic could be greatly reduced.

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Structural limitations include:

      • Floor strength
      • Stairs
      • Adequate door width
      • Proper foundation
      • Adequate ventilation
      • Home suitable for equipment/service

It is important to check the structural integrity of your homes flooring to help prevent falling, stubbing your toe on a lifted board, or any other avoidable injury caused by flooring in need of repair. Your floor is one of the most basic elements of your home. If the floors have issues, they need to be address as soon as possible.

Stairs are also another safety risk when assessing a home. Any stairs within the home must be in good condition, and you must repair any lose boards found within the inspection. By doing so, you can help avoid falling down the stairs.

Door width is another factor to consider, as you may become wheelchair bound and need to navigate your home easily. Standard door width for an interior door is 36 inches . However, both 30 and 32 inches are available. A typical wheelchair is 32 inches wide. Thus, the standard 36-inch-wide door is a preferred.

Getting down to the basics, having a stable foundation is one of the most important aspects of your home’s safety. A faulty foundation can cause your home to sink and shift causing cracks, uneven floors an unlevel ceilings. If let go for too long, a damaged foundation can be detrimental to the structural integrity of your home.

Adequate ventilation is another key factor in ensuring your home is safe for you and your loved ones. Having properly working vents can ensure you are breathing fresh and uncontaminated air. This is especially important for individuals with lung issues, such as COPD

Once the main components of your home have been assessed, it is important to assess where how suitable you home is overall for medical equipment. You should know what types of home medical equipment may or may not fit inside of your house and recommendations for installation locations.

Home Fall Risk Safety Assessment

While the statics show that 1 in 4 Americans over age 65 fall each year, falling isn’t inevitable, and most falls can be prevented with a willingness to make a few changes.

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Fall risk assessments include:

      • Throw rugs or runners
      • Loose carpeting
      • Extension cords in walkways
      • Uses O2 tubing over 25 feet
      • Clutter environment objects blocking the walkways
      • Pets in a home that could cause a fall

To make your home as safe as possible, you should consider removing and replacing any loose carpeting or rugs. If you have throw rugs on the floor, consider double-sided tape or a non-slip backing to prevent falls.

Further, you should avoid the use of extension cords in the walkways. If you must utilize extension cords, consider taping them next to a wall.

Using O2 tubing longer than 25 feet can cause tangling, kinks, or even become a tripping hazard.

Additionally, as tempting as it might be to save old magazines or books, everything needs to be off the floor to reduce the risk of tripping hazards.

Lastly, having pets in your old age can become a huge liability. Pets can cause you to trip and also require a ton of attention, walks, and care. Rethinking a pet in retirement may be the best option for some.

“Reducing fall risks for older Americans is one of the most important things we can do to help protect their health and safety. Falls are one of the most common and most deadly accidents that happen among this age group. “Says Ashlee Zareczny, Compliance Manager at Elite Insurance Partners.

She continues, “By making small modifications to their homes, seniors live more comfortably knowing they are at a reduced risk of falling”.

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Fire Hazard Assessment

The use of home oxygen is commonplace. But, most users may not be aware that oxygen under high pressure can be volatile.

The use of oxygen in your home can heighten your risk for a house fire. Thus, you will need to take additional precautions. Because of this heightened risk, a fire hazard assessment is completed during your home safety assessment to ensure you do everything you can to avoid a devastating house fire.

If you require the use of oxygen, your home assessor may recommend you post a “no smoking” sign inside of your home. This will reduce the potential for open flames in the home. Additionally, you may need to discuss further modifications to your home if you cook on a gas stove. The open flame provided by your stove mixed with the increased oxygen in the air can cause a heightened risk for combustion.

Additionally, you will want to strategically place your back-up oxygen tanks in a location that is safe, and temperature controlled. This will lower any risks for a sporadic house fire.

Home Electrical Safety Assessment

Having safe electrical wiring throughout your home will help prevent hazardous shocks and fires. Your inspector will review your electrical during a home safety assessment. However, when you obtain specific medical equipment, such as a home ventilator machine, it would require a more thorough assessment of the home’s electrical system.

Electrical factors include:

      • Sufficient electricity
      • Safe wiring
      • Outlets
      • Grounding
      • Power strips

How to Get Medicare Coverage for a Home Safety Assessment

You may be eligible for Medicare coverage of a home safety assessment if your doctor orders one due to a recent hospitalization cause by a preventable home safety issue. Also, those with home health care could be eligible for an evaluation to ensure the safety of you and your home health care provider.

In most cases, your home safety assessment is covered by your Medicare Part B benefits. However, if the assessment is preformed due to your enrollment in home healthcare, Medicare Part A will cover your costs. Regardless, a typical home safety assessment can cost you anywhere from $50 – $200 out of pocket depending on your coverage.

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For more information, or to review your coverage options, give us a call at the number above or fill out our online rate form to see supplemental Medicare options available in your area.

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Centers for Disease Control and Prevention, Older Adult Fall Prevention. Accessed April 2024.
    https://www.cdc.gov/falls/facts.html
  2. Centers for Disease Control and Prevention, Injury Prevention and Control . Accessed April 2024.
    https://www.cdc.gov/injury/features/older-adult-falls/index.html
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

15 thoughts on "Does Medicare Cover Home Safety Assessments"

  1. Hi I don’t see anywhere on CMS that Medicare covers a home safety assessment. I also don’t see a CPT code anywhere. Is this still a covered benefit?

  2. Is a mobile outpatient therapist able to bill for this if a MD writes the order for “OT Eval and Treat.” this article makes it seem like it needs to be run through a home health agency, or be approved by a local Area Agency on Aging prior?

    1. Hi Dawn! This is a tricky one. The article points out that a home health agency must be Medicare-approved to do the home safety assessment. I would assume the same would apply with a mobile outpatient therapist. However, I would call Medicare directly to confirm.

    1. Hi Emily! I would contact Medicare directly to confirm, but I believe occupational therapists can bill Medicare for the home safety assessment. This PDF from CMS may provide additional insight as well.

    1. Hi Michael! Given you have to access the safety of the home, I don’t think it can be done virtually. However, I would contact the company that would be doing the assessment to see if they offer it via Telehealth.

    1. Toni, you are so very welcome! We don’t have them on hand to access, however, I did some research and I believe the PDF here may have them. The top of page two has CPT codes for both physical and occupational therapists to do home assessments. I hope this helps!

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