c-leg reimbursement responses

c-leg reimbursement responses

nathan keepers

1/10/2004

Here are the responses to my inquiry on C-Leg reimbursement in medicare
Region D.


They will only pay for a B-leg and only then at 50%

Region D C-Leg reimbursment.
Medicare announced not paying for the real time gait analysis code because
it
was included in the microprocessor coding. Otherwise, reimbursment has been
ok.
We have fit about 6-7 Cegs.

I recieved partial payment from Medicare region B., it was a hassle.

hi nathan give me acall
(Resulted in this person informing me that they have fit 2 at an office and
had no problem with correct documentation and left out the 99 code for real
time gait analysis.)

Nathan
Might I suggest you contact Aopa, Otto Bock and Hanger whom surley are in
the loop on reimbursement for Region D for the C-leg.
(I do know that Ottobock has a reimbursement specialist, have not talked to
him)

We have had problems with Region D. We have one case in review and a
second just received denial on the C-Leg components due to lack of
medical necessity. We are waiting on a telephone review of the first
case.
We sign ABN's now referencing the potential for denial regarding the
medical necessity denial. It doesn't look good at this point.

I know it probably doesn't help you out, but I've experienced minimal
difficulties in region B as long as the appropriate documentation is
included...ie: CMN.


Nathan Keepers, CPO

_________________________________________________________________
Get a FREE online virus check for your PC here, from McAfee.
<URL Redacted>