US-policy CMS denial
Gary Berke
Description
Collection
Title:
US-policy CMS denial
Creator:
Gary Berke
Date:
6/9/2009
Text:
Dear List
We have received several denials from Medicare on the repair of a C-Leg. The
prosthesis was paid for by CMS and is now out of warranty. The latest cost
to repair was approximately $5000. We have billed under 7510-RP. CMS stated
that the 7510 (replacement of minor parts) has a maximum number of units of
4 units. unfortunately it takes more than 4 units to achieve the 5000. cost
for the repair.
Does anyone have any recommendations on how to get this reimbursed?
Different codes, different approach and appeal recommendations are welcome.
We have several C-Legs that Medicare provided that may need future repairs.
Any recommendations are most appreciated. Thank you in advance for your
responses. I will keep your responses confidential if reposted to the list.
Gary M. Berke MS, CP
Adjunct Clinical Instructor,
Department of Orthopaedic Surgery
Stanford University
We have received several denials from Medicare on the repair of a C-Leg. The
prosthesis was paid for by CMS and is now out of warranty. The latest cost
to repair was approximately $5000. We have billed under 7510-RP. CMS stated
that the 7510 (replacement of minor parts) has a maximum number of units of
4 units. unfortunately it takes more than 4 units to achieve the 5000. cost
for the repair.
Does anyone have any recommendations on how to get this reimbursed?
Different codes, different approach and appeal recommendations are welcome.
We have several C-Legs that Medicare provided that may need future repairs.
Any recommendations are most appreciated. Thank you in advance for your
responses. I will keep your responses confidential if reposted to the list.
Gary M. Berke MS, CP
Adjunct Clinical Instructor,
Department of Orthopaedic Surgery
Stanford University
Citation
Gary Berke, “US-policy CMS denial,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/230449.
