Question about L1843 Medicare LCD Jurisdiction C

Question about L1843 Medicare LCD Jurisdiction C

Rachel Sidle

2/3/2014

Dear List,

I had a pt in the office today with severe genu varum that has been wearing
an unloading single upright KO for 11 years, and it is needing to be
replaced. The problem is that my interpretation of the Medicare LCD #22664
for knee orthoses states that L1843 is either covered if the pt has had a
recent injury or surgery and OA, or has hemiplegia/MS/CP. He has OA and a
severe deformity, but is using the brace to prevent surgery. He has
already had a TKA on his other side, but is 90 years old and does not want
another surgery and he is managed well with the KO.

Am I just misinterpreting the LCD? L1843 singe upright unloading KO was
designed for varus/valgus deformity and OA, but Medicare seems to only want
to pay if they had a recent injury or surgery.

We sent him to his PCP for documentation of his needs, but would like to
let him know when he returns if Medicare will cover it or not.

If you have a different understanding of the coverage, please let me know,
and please back it up with documentation if you have it. Or if you have
had L1843 covered without injury or surgery, please let me know.

Thanks.

Rachel Sidle, CPO, LPO
Memphis, TN