Re: temporary prostheses
Marty Mandelbaum
Description
Collection
Title:
Re: temporary prostheses
Creator:
Marty Mandelbaum
Date:
5/16/2001
Text:
On Tue, 15 May 2001, Marty Mandelbaum wrote:
Are there Medicare guidelines pertaining to billing a temporary prosthesis
with Alpha liners and acrylic laminations not being covered?
Three responses, Thank you.
1--The way I understand it, acrylic is not covered for any level on the
temporary. Suction Liners are covered for Tf not TT
Wendy
2--It is written in the Lower Limb Prosthetic Policy in your DMERC
regulation book. Trying to have this aspect changed, as it now is a standard
of care. At the
time the policy was written, it was not.
they stoped paying for Silicon liners on Temps. I never did laminated temps,
so I don't know about that modifier
Wade B
3--L5629 (acrylic socket), L5667 (insert with lock), and L5669 (insert w/o
lock)
are considered not medically necessary for use with the following base
codes:
1. L5500 (Initial)
2. L5510-5530 (Preparatory)
3. L5535 (Preparatory-Pre-fab)
Your DMERC Supplier Manual addresses this as well as other coverage issues.
Gary A. Cheney, CPO, FAAOP
Are there Medicare guidelines pertaining to billing a temporary prosthesis
with Alpha liners and acrylic laminations not being covered?
Three responses, Thank you.
1--The way I understand it, acrylic is not covered for any level on the
temporary. Suction Liners are covered for Tf not TT
Wendy
2--It is written in the Lower Limb Prosthetic Policy in your DMERC
regulation book. Trying to have this aspect changed, as it now is a standard
of care. At the
time the policy was written, it was not.
they stoped paying for Silicon liners on Temps. I never did laminated temps,
so I don't know about that modifier
Wade B
3--L5629 (acrylic socket), L5667 (insert with lock), and L5669 (insert w/o
lock)
are considered not medically necessary for use with the following base
codes:
1. L5500 (Initial)
2. L5510-5530 (Preparatory)
3. L5535 (Preparatory-Pre-fab)
Your DMERC Supplier Manual addresses this as well as other coverage issues.
Gary A. Cheney, CPO, FAAOP
Citation
Marty Mandelbaum, “Re: temporary prostheses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/216630.
