BlueCross and BlueShield of Montana Medical Policy/Codes
Custodial Care
Chapter: Administrative
Current Effective Date: December 27, 2013
Original Effective Date: March 24, 1986
Publish Date: December 27, 2013
Revised Dates: May 14, 2003; April 11, 2007; November 14, 2011; December 11, 2013
Description

Custodial Care means care which does not require the continuous services of skilled or trained medical, paramedical, or allied health professional personnel.

Essentially custodial care is designed to assist patients in meeting the activities of daily living and to maintain life and/or comfort with no reasonable expectation of cure or improvement of sickness or injury.  Examples of custodial care include, but are not limited to:

  • help in walking or getting in or out of bed;
  • assistance in bathing, dressing, feeding, and using toilet facilities;
  • preparation of diets and nutritional supplements,
  • supervision over medication preparation and administration and treatments that are self administered;
  • provision of socially necessary services such as room and board;
  • services as a result of court-ordered confinements, during which the patient’s ongoing medical treatment is continued but is secondary to the court ordered confinement.
Policy

Each benefit plan or contract defines which services are covered, which are excluded, and which are subject to dollar caps or other limits.  Members and their providers have the responsibility for consulting the member's benefit plan or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply.  If there is a discrepancy between a Medical Policy and a member's benefit plan or contract, the benefit plan or contract will govern.

Coverage

Custodial care, defined as care which does not require the continuous services of skilled or trained medical, paramedical, or allied health professional personnel is not a covered benefit by most health care contracts as these services are generally non medical in nature.

Medically necessary care provided by a physician or other qualified health care professional to a patient in a custodial care facility is eligible for coverage.

Rationale

See Coverage section.

Coding

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps. 

ICD-9 Codes
Refer to the ICD-9-CM manual.
ICD-10 Codes
Refer to the ICD-10-CM manual.
Procedural Codes: 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99509
References
  1. BCBSA TEC, Uniform Medical Policy Manual, Archive, 12/92, pages 38.0-38.1.
History
November 2011  Policy review date updated. Policy is not scheduled for regular review.
December 2013 Policy formatting and language revised.  Policy statement unchanged.
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CPT codes, descriptions and material only are copyrighted by the American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use. CPT only © American Medical Association.
Custodial Care