Re: Initial feet for new Amputees-Medicare Considerations-USA
Benveniste, David Mark
Description
Collection
Title:
Re: Initial feet for new Amputees-Medicare Considerations-USA
Creator:
Benveniste, David Mark
Date:
1/24/2006
Text:
I received an additional interesting post which offers useful and
updated Medicare policy, with respect to appropriate and Medicare
allowed selection of the initial foot. It appears there is already a
much more reasonable policy in place.
Mark Benveniste RN BS CP
MEDVA Medical Center
Houston, TX
USA
________________________________
Post
With interest I have been following the list serve posts relating to the
above matter. I will say that I and apparently many others totally agree
with your position. When indicated, the use of a dynamic/energy
responsive prosthetic foot for the initial prosthesis is a very
acceptable standard of practice.
My comments are directed to the response you recently posted from the
individual that felt use of these feet would be in violation of
Medicare rules and regulations. .................. They have made an
assumption that a patients first prosthesis must be a preparatory and no
Medicare medical policy requires such. Their comments are based on their
interpretation of antiquated treatment protocol. Additionally, Medicare
does require sufficient clinical documentation to support medical
necessity but does not require progression from one functional level
classification to the next.
Medicare policy addresses the use of prosthetic feet other than SACH and
states the following in pertinent parts:
A determination of the type of foot for the prosthesis will be made by
the treating physician and/or prosthetist based upon the functional
needs of the patient
A determination of the medical necessity for certain
components/additions to the prosthesis is based on the patient's
potential functional abilities. Potential functional ability is based on
the reasonable expectations of the prosthetist, and treating
physician...
The records must document the patient's current functional capabilities
and his/her expected functional potential, including an explanation for
the difference, if that is the case
Medical policy is very specific as to the need to document the patients
current or expected functional potential for Medicare coverage of feet
other then SACH. It does not require the use of a preparatory prosthesis
or does it require documentation indicating progression of the
patients functional level. It requires the physician and prosthetist to
determine functional level based upon reasonable expectations.
________________________________
updated Medicare policy, with respect to appropriate and Medicare
allowed selection of the initial foot. It appears there is already a
much more reasonable policy in place.
Mark Benveniste RN BS CP
MEDVA Medical Center
Houston, TX
USA
________________________________
Post
With interest I have been following the list serve posts relating to the
above matter. I will say that I and apparently many others totally agree
with your position. When indicated, the use of a dynamic/energy
responsive prosthetic foot for the initial prosthesis is a very
acceptable standard of practice.
My comments are directed to the response you recently posted from the
individual that felt use of these feet would be in violation of
Medicare rules and regulations. .................. They have made an
assumption that a patients first prosthesis must be a preparatory and no
Medicare medical policy requires such. Their comments are based on their
interpretation of antiquated treatment protocol. Additionally, Medicare
does require sufficient clinical documentation to support medical
necessity but does not require progression from one functional level
classification to the next.
Medicare policy addresses the use of prosthetic feet other than SACH and
states the following in pertinent parts:
A determination of the type of foot for the prosthesis will be made by
the treating physician and/or prosthetist based upon the functional
needs of the patient
A determination of the medical necessity for certain
components/additions to the prosthesis is based on the patient's
potential functional abilities. Potential functional ability is based on
the reasonable expectations of the prosthetist, and treating
physician...
The records must document the patient's current functional capabilities
and his/her expected functional potential, including an explanation for
the difference, if that is the case
Medical policy is very specific as to the need to document the patients
current or expected functional potential for Medicare coverage of feet
other then SACH. It does not require the use of a preparatory prosthesis
or does it require documentation indicating progression of the
patients functional level. It requires the physician and prosthetist to
determine functional level based upon reasonable expectations.
________________________________
Citation
Benveniste, David Mark, “Re: Initial feet for new Amputees-Medicare Considerations-USA,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/225995.
