L5651 Coverage on Preparatories
John Brinkmann
Description
Collection
Title:
L5651 Coverage on Preparatories
Creator:
John Brinkmann
Date:
1/2/2004
Text:
Dear List Members,
Happy New Year! Here are some responses that I received to my question
regarding Medicare coverage of flexible inner liner/external frame for a
preparatory AK. The answers varied - some said that this code is covered,
others said it isn't. This may be related to which Region is in question.
Special thanks to Jackie at Walkabout Orthotics and Prosthetics and others
who took the time to research and send info directly from the Supplier
Manuals. I was using the base code L5590 - not a prefabricated preparatory.
John Brinkmann, CPO, FAAOP
_________
As per Region C DMEPOS Supplier Manual (Autumn 2003) Lower Limb Prostheses
Page 53.3, L5651 and many other codes will be denied as not medically
necessary on preparotory prostheses.
_________
When an above knee preparatory prefabricated prosthesis (L5585) is
provided, prosthetic substitution and/or additions of procedures and
components are covered in accordance with the functional level assessment
except for codes L5624, L5631, L5648, L5651, L5652, L5705, L5706, L5964, and
L5966 which will be denied as not medically necessary.
_________
Medicare Medical Review Policy denies coverage for L5651 if the base code
for the preparatory is L5585 (preparatory-prefabricated). The remaining
preparatory base codes (L5560-L5580, L5590-L5600) do not exclude coverage
for L5651.
__________
From the Region B Manual:
When an above knee initial prosthesis (L5505) or an above knee preparatory
(L5560 � L5580, L5590 � L5600) prosthesis is provided, prosthetic
substitution and/or additions of procedures and components are covered in
accordance with the functional level assessment except for codes L5610,
L5631, L5640, L5642, L5644, L5648, L5705, L5706, L5964, L5980, and L5710 �
L5780, L5790 � L5795 which will be denied as not medically necessary. When
an above knee preparatory prefabricated prosthesis (L5585) is provided,
prosthetic substitution and/or additions of procedures and components are
covered in accordance with the functional level assessment except for codes
L5624, L5631, L5648, L5651, L5652, L5705, L5706, L5964, and L5966 which will
be denied as not medically necessary.
_________________________________________________________________
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<URL Redacted>
Happy New Year! Here are some responses that I received to my question
regarding Medicare coverage of flexible inner liner/external frame for a
preparatory AK. The answers varied - some said that this code is covered,
others said it isn't. This may be related to which Region is in question.
Special thanks to Jackie at Walkabout Orthotics and Prosthetics and others
who took the time to research and send info directly from the Supplier
Manuals. I was using the base code L5590 - not a prefabricated preparatory.
John Brinkmann, CPO, FAAOP
_________
As per Region C DMEPOS Supplier Manual (Autumn 2003) Lower Limb Prostheses
Page 53.3, L5651 and many other codes will be denied as not medically
necessary on preparotory prostheses.
_________
When an above knee preparatory prefabricated prosthesis (L5585) is
provided, prosthetic substitution and/or additions of procedures and
components are covered in accordance with the functional level assessment
except for codes L5624, L5631, L5648, L5651, L5652, L5705, L5706, L5964, and
L5966 which will be denied as not medically necessary.
_________
Medicare Medical Review Policy denies coverage for L5651 if the base code
for the preparatory is L5585 (preparatory-prefabricated). The remaining
preparatory base codes (L5560-L5580, L5590-L5600) do not exclude coverage
for L5651.
__________
From the Region B Manual:
When an above knee initial prosthesis (L5505) or an above knee preparatory
(L5560 � L5580, L5590 � L5600) prosthesis is provided, prosthetic
substitution and/or additions of procedures and components are covered in
accordance with the functional level assessment except for codes L5610,
L5631, L5640, L5642, L5644, L5648, L5705, L5706, L5964, L5980, and L5710 �
L5780, L5790 � L5795 which will be denied as not medically necessary. When
an above knee preparatory prefabricated prosthesis (L5585) is provided,
prosthetic substitution and/or additions of procedures and components are
covered in accordance with the functional level assessment except for codes
L5624, L5631, L5648, L5651, L5652, L5705, L5706, L5964, and L5966 which will
be denied as not medically necessary.
_________________________________________________________________
Worried about inbox overload? Get MSN Extra Storage now!
<URL Redacted>
Citation
John Brinkmann, “L5651 Coverage on Preparatories,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/222332.
