Ultralight material denials?
Rachel Sidle
Description
Collection
Title:
Ultralight material denials?
Creator:
Rachel Sidle
Date:
11/5/2013
Text:
Dear List,
We just got 2 denials for ultralight material: 1 for a Bilateral BK and 1
for an AK. Both have Medicare primary and Medicare denied the ultralight
material codes L5950 and L5940 and said that it is not medically
necessary.
Both were done on definitive prostheses and not preparatory. Both were
billed in conjunction with an acrylic socket code. Both were billed
because carbon fiber was used, which is when Medicare says that they will
pay for ultralight material. (Effective January 2013, Medicare says that
L5940-L5960 can be used when either carbon fiber, fiberglass, kevlar, or
other advanced composite lamination materials are used during fabrication
of the socket.)
We cannot find any guidelines that say that it is no longer covered.
Is anyone else having this problem? We are going to appeal, but are
wondering why this is happening. We got one and thought it was random,
until we got the second one today.
Any comments?
Rachel Sidle, CPO, LPO
Memphis, TN
We just got 2 denials for ultralight material: 1 for a Bilateral BK and 1
for an AK. Both have Medicare primary and Medicare denied the ultralight
material codes L5950 and L5940 and said that it is not medically
necessary.
Both were done on definitive prostheses and not preparatory. Both were
billed in conjunction with an acrylic socket code. Both were billed
because carbon fiber was used, which is when Medicare says that they will
pay for ultralight material. (Effective January 2013, Medicare says that
L5940-L5960 can be used when either carbon fiber, fiberglass, kevlar, or
other advanced composite lamination materials are used during fabrication
of the socket.)
We cannot find any guidelines that say that it is no longer covered.
Is anyone else having this problem? We are going to appeal, but are
wondering why this is happening. We got one and thought it was random,
until we got the second one today.
Any comments?
Rachel Sidle, CPO, LPO
Memphis, TN
Citation
Rachel Sidle, “Ultralight material denials?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/235831.
