Medicare billing question

Medicare billing question

Paula Pivko

3/19/2012

Hi everyone, I am having a discussion with my billing manager. I have a patient referred to me for a hand brace. In the course of the eval the therapist stated the AFO also wasn't fitting correctly. It wasn't something we made and he got it 6 months ago. It is a solid ankle AFO. He is contracted, the AFO is set at 90, and the heel is not all the way down in the AFO. He is pulling out of it. I would like to do an AFO with joints and an adjustable stop, possibly some type of SMO insert to get him down into the brace and stretch the contracture. Our question is: will Medicare cover the cost of another AFO of any type so soon? What sort of documentation would we need from the MD? I'm thinking a detailed RX, face to face visit, with clinical notes and an LMN. The patient is post-CVA, about 6 or 7 months. Thank you for your help as usual. Paula Martinek, LPO
 
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