Broken AFO
David Hansford
Description
Collection
Title:
Broken AFO
Creator:
David Hansford
Date:
9/4/2015
Text:
Just to clarify my previous question regarding the replacement of an AFO.
The AFO in question is 18 months old. I do not know what the original
provider billed for (custom, OTC or custom fit). The patient has no idea
what was billed to Medicare as far as the type of AFO and I have no way of
checking, that I know of. I know that it is a carbon OTC type brace and I
see no signs of modifications.
The AFO broke as a result of material fatigue and failure. If understand of
the LCD, only AFOs that are damaged by some accident or event are covered
for replacement. This is not from accidental damage. Would it then be
considered as wear and tear (which is not a coverage criteria)?
Please let me know what to tell the patient? Are they now going to have to
pay out of pocket as a non-covered replacement, or wait 5 years for
replacement that is covered and billable to Medicare?
David Hansford, CPO
The AFO in question is 18 months old. I do not know what the original
provider billed for (custom, OTC or custom fit). The patient has no idea
what was billed to Medicare as far as the type of AFO and I have no way of
checking, that I know of. I know that it is a carbon OTC type brace and I
see no signs of modifications.
The AFO broke as a result of material fatigue and failure. If understand of
the LCD, only AFOs that are damaged by some accident or event are covered
for replacement. This is not from accidental damage. Would it then be
considered as wear and tear (which is not a coverage criteria)?
Please let me know what to tell the patient? Are they now going to have to
pay out of pocket as a non-covered replacement, or wait 5 years for
replacement that is covered and billable to Medicare?
David Hansford, CPO
Citation
David Hansford, “Broken AFO,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237666.
