Test sockets

Test sockets

Dear Colleagues and guests,

I have been told that Medicare does not allow the use of prosthetic test
socket codes for use with orthotic thigh components. However, they will
allow the use of lower limb orthotic add-on codes to be used for spinal
devices, i.e., hip joint and thigh cuff addition.

How is a test socket applied for a thigh component of a KAFO different from a
test socket applied for a trans-femoral prosthesis, other than the bottom of
it is cut out? I have been told that Medicare does not pay for diagnostic
procedures and that they are considering a removal of the prosthetic test
socket codes for this reason. What is diagnostic about a test socket? What
does it diagnose? In my opinion, an O&P test socket is much like a
post-surgical x-ray. It verifies that the intended outcome has happened,
except in our case, or is about to happen. Or, it reveals any shortcomings
of the surgery or, in our case, intended socket goal. Does Medicare pay for
post-surgical x-rays?

I believe we need to approach Medicare officials with questions about this.
Does anyone think a test socket is an unreasonable procedure for obtaining
optimum outcome results? Thanks again for your replies.

Wil Haines, CPO