Replacement of Consumables

Replacement of Consumables

Eric Schwelke CPO LPO

3/4/2010

Regarding my original question:

Can someone direct me to any information about the
following:

For Medicare patients>>>>>>>>>>>

Are Rx's needed for replacement consumable items, i.e.,
(suspension belts such as TES or PowerBelts, socks, sheaths, suspension
sleeves, gel liners) for existing prostheses? If not, are there time limits
on how long the original Rx for the prosthesis would be eligible to use for
these consumable replacements on an ongoing basis?

I have received 10 responses:

* 3 responders believe that an Rx is NOT required based on information
they have received either through the AOPA Coding/Billing seminar, or from
the Local Coverage Determinations of their respective DME MAC;

* 3 responders were emphatic about getting an Rx for any and all items
no matter the circumstances;

* 3 responders are uncertain and wanted to know more information;

* 1 response was from a user who appears to be very upset that an Rx
has been required of them over many years for any item including socks.

Going through the CMS website, I have found this text in a policy article
from our DME MAC in the Northeast:

Replacement of a prosthesis or prosthetic components required because of
loss or irreparable damage may be reimbursed without a physician's order
when it is determined that the prosthesis as originally ordered still fills
the patient's medical needs.

Although there is no specific language regarding consumables, it appears
to me that this language would support issuing replacements for consumable
items for the original prosthesis without a new Rx and no time limit. Of
course, there is a comfort zone for each practice and your own policies
and procedures should reflect that.

Here is the link to the policy article:

<URL Redacted>
ion=12&contractor_id=137

Thanks to all,

Eric Schwelke CPO LPO