Test Socket Billing Responses

Test Socket Billing Responses

John T. Brinkmann, CPO, FAAOP

10/24/2002

Original Question:
Medicare recently denied coverage for a second test socket for an AK
patient on the grounds that two test sockets could not be provided on
one day. We routinely submit all the prosthetic codes involved in
providing the prosthesis at the same time, using the same date of
service for all of them. Since the test sockets are provided earlier
than the final prosthesis, is it acceptable to bill for them using an
earlier date of service?

Respones:


John - what will they think of next (Medicare)? We have always billed
for
both test sockets using the same date of service. It has never been a
problem.

*****

Test sockets must be dated prior to the delivery of the prosthesis and
if two test sockets are used they cannot be on the same date but still
prior to the delivery date. And yes they can be placed on the same
billing as the final prosthesis.

*****

I've never had a problem getting paid for 2 test sockets (quantity two)
from
Medicare. This is their official quantity unless they've changed it in
the
last month.

*****

John, It sounds like you got a rookie reviewer.

You are billing correctly. If you have appropriate documentation for why
two
test sockets were necessary it should be covered.

I would submit something like the following paragraph in your appeal.
You
may want to ask for a telephone hearing. We have had those resovled in
cases
like this. Even before we were called, they just sent a note that they
reviewed the materials and found we should have been paid.

In accordance with your policies we bill for prosthetic devices when
they
are completed and delivered. Even though we did not fit the amputee on
the
same day with the two test sockets, we did bill for them on the date
that we
delivered the device. I do not know where the policy language exists,
if
you are an AOPA member Patrick Kelly may be able to help you locate it.


Thanks to all who responded.

John Brinkmann, CPO, FAAOP