Re: New Medicare Prosthetic Coverage Requirements?
Karl Entenmann
Description
Collection
Title:
Re: New Medicare Prosthetic Coverage Requirements?
Creator:
Karl Entenmann
Date:
1/21/2013
Text:
The question here is whether the prosthesis codes are still exempt from SNF pps billing. As I understood in the past, specific codes were exempt from pps and this checklist appears to say the opposite. I believe there were issues about a prosthesis being fitted in the hospital under Medicare part A, but that in an SNF, those specific codes were exempt from pps billing and we could in the past bill CMS for those codes (prep or definitive prosthesis) even during the part A stay. AOPA needs to clarify this because I believe it is in error.
Karl Entenmann, CPO
Preferred O and P
Federal Way, Wa
Sent from my iPad
On Jan 21, 2013, at 12:06 PM, Brett R. Saunders, CPO, FAAOP < <Email Address Redacted> > wrote:
> CGS Medicare has published a new Prosthetic Documentation Checklist and if I read this correctly,
>
> Prosthetic devices can only be delivered to patients in SNF units if:
>
> 1 It will be medically necessary after discharge, AND
> 2 Is fit and delivered within 2 days of discharge from the SNF, AND
> 3 Is NOT needed for inpatient treatment or rehabilitation.
>
> Is this a new change in policy on coverage for prosthetics??
>
> The document I am referencing is found at cgsmedicare.com/jc/coverage/mr/PDF/MR_checklist_LLP.pdf
>
> How could a prosthesis NOT be considered as needed for inpatient treatment and rehabilitation?
>
>
> Brett R. Saunders, CPO, FAAOP
>
>
>
Karl Entenmann, CPO
Preferred O and P
Federal Way, Wa
Sent from my iPad
On Jan 21, 2013, at 12:06 PM, Brett R. Saunders, CPO, FAAOP < <Email Address Redacted> > wrote:
> CGS Medicare has published a new Prosthetic Documentation Checklist and if I read this correctly,
>
> Prosthetic devices can only be delivered to patients in SNF units if:
>
> 1 It will be medically necessary after discharge, AND
> 2 Is fit and delivered within 2 days of discharge from the SNF, AND
> 3 Is NOT needed for inpatient treatment or rehabilitation.
>
> Is this a new change in policy on coverage for prosthetics??
>
> The document I am referencing is found at cgsmedicare.com/jc/coverage/mr/PDF/MR_checklist_LLP.pdf
>
> How could a prosthesis NOT be considered as needed for inpatient treatment and rehabilitation?
>
>
> Brett R. Saunders, CPO, FAAOP
>
>
>
Citation
Karl Entenmann, “Re: New Medicare Prosthetic Coverage Requirements?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/234527.
