Responses to the PRAFO Code
Paul Boland, CPO
Description
Collection
Title:
Responses to the PRAFO Code
Creator:
Paul Boland, CPO
Date:
10/3/2000
Text:
Basically we are going to appeal the claim with Medicare with L2999.
Unfortunately this will take up more time but the other codes reimburse at
$40.00 over cost.
________________________
Try the Medicare manual. Look at the codes L4310 or L4320. They are not
covered by Medicare. Call the DMERC for clarification.
_________________________
Medicare's policy is very specific on devices that fit this type. Refer to
your DMERC manual on positioning splints for Ankle Contractures/Foot
Positioning Splints and Recumbent Splints.
Match the device, its intended use to the definitions they have and select
the appropriate code. In some cases Medicare may not cover the device you
have been asked to provide. If that is the case you can ask the patient to
pay. If you do have a case wherer they will cover thed evice check the
allowable as they are low with recpect to some devices of this variety.
Some of the policy can be found below
AFOs used in Non-ambulatory patients:
L4396
Patients must meet policy required criteria
Measurements also required for treatment of plantar flexion contracture
Medicare does not reimburse for a drop foot splint/recumbent positioning
device or replacement interface
__________________________________
I believe that there is no applicable code. We searched this one ourselves
and finally had to charge the patient and bill for them. Tried a few things
and all got denied. Good luck.
________________________________
I'm not sure what code you are using but if this is a prefab multipodus
splint then the appropriate code is L-4396. Did the hospital tell you to use
the miscellaneous code?
There are actually a couple of codes for the multi-podus boot, mpo phase 2
which is L-2999, mpo shortback and mpo2000 are both L-4396. I've never seen
the PRAFO letters before so if I am completely off base I appologize. If I am
off base on this one, please let me know what prafo stands for.
______________________
The AOPA Coding Committee recommends L4396 for non-ambulatory use. For
ambulatory use I believe you should use a misc. code.
_______________________
Unfortunately this will take up more time but the other codes reimburse at
$40.00 over cost.
________________________
Try the Medicare manual. Look at the codes L4310 or L4320. They are not
covered by Medicare. Call the DMERC for clarification.
_________________________
Medicare's policy is very specific on devices that fit this type. Refer to
your DMERC manual on positioning splints for Ankle Contractures/Foot
Positioning Splints and Recumbent Splints.
Match the device, its intended use to the definitions they have and select
the appropriate code. In some cases Medicare may not cover the device you
have been asked to provide. If that is the case you can ask the patient to
pay. If you do have a case wherer they will cover thed evice check the
allowable as they are low with recpect to some devices of this variety.
Some of the policy can be found below
AFOs used in Non-ambulatory patients:
L4396
Patients must meet policy required criteria
Measurements also required for treatment of plantar flexion contracture
Medicare does not reimburse for a drop foot splint/recumbent positioning
device or replacement interface
__________________________________
I believe that there is no applicable code. We searched this one ourselves
and finally had to charge the patient and bill for them. Tried a few things
and all got denied. Good luck.
________________________________
I'm not sure what code you are using but if this is a prefab multipodus
splint then the appropriate code is L-4396. Did the hospital tell you to use
the miscellaneous code?
There are actually a couple of codes for the multi-podus boot, mpo phase 2
which is L-2999, mpo shortback and mpo2000 are both L-4396. I've never seen
the PRAFO letters before so if I am completely off base I appologize. If I am
off base on this one, please let me know what prafo stands for.
______________________
The AOPA Coding Committee recommends L4396 for non-ambulatory use. For
ambulatory use I believe you should use a misc. code.
_______________________
Citation
Paul Boland, CPO, “Responses to the PRAFO Code,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/215193.
