Re: Wrist brace frequency
Lesleigh Sisson
Description
Collection
Title:
Re: Wrist brace frequency
Creator:
Lesleigh Sisson
Date:
6/14/2020
Text:
There is not an LCD for upper extremity orthoses. However there is a Standard
Documentation Requirements Policy Article - A55426
< <URL Redacted> >.
You can find it here:
<URL Redacted>
In the Policy Article you will find replacement criteria for all orthoses.
Reasonable Useful Lifetime for all orthoses is 5 year with the exception of
knee orthoses (the knee orthoses LCD for those specifics).
REPLACEMENT
The definition of replacement is found in the CMS Benefit Policy Manual
(Internet-only manual 100-02), Chapter 15, Section 110.2.C. That section
generally defines replacement as the provision of an entirely identical or
nearly identical item when it is lost, stolen or irreparably damaged.
Beneficiary owned items or a capped rental item may be replaced in cases of
loss or irreparable damage. Irreparable damage may be due to a specific
accident or to a natural disaster (e.g., fire, flood). Contractors may
request documentation confirming details of the incident (e.g., police
report, insurance claim report).
Replacement of items due to irreparable wear takes into consideration the
Reasonable Useful Lifetime (RUL) of the item. The RUL of DME is determined
through program instructions. In the absence of program instructions,
carriers may determine the RUL, but in no case can it be less than 5 years.
If the item has been in continuous use by the beneficiary on either rental
or purchase basis for its RUL, the beneficiary may elect to obtain a
replacement.
Medicare does not cover replacement for items in the frequent and
substantial servicing payment category, oxygen equipment, or inexpensive or
routinely purchased rental items.
A treating practitioner’s order and/or new CMN, when required, is needed to
reaffirm the medical necessity of the item for replacement of an item.
*Lesleigh Sisson, CFom*
702-400-1661
This message (and any associated files) is intended only for the use of the
individual or entity to which it is addressed and may contain information
that is confidential. If you are not the intended recipient you are hereby
notified that any dissemination, copying or distribution of this message,
or files associated with this message, is strictly prohibited. If you have
received this message in error, please notify the sender immediately by
replying to the message and deleting it from your computer.
On Sun, Jun 14, 2020 at 6:57 AM Darya Shahrokhi <
<Email Address Redacted> > wrote:
> Hi all,
> Any body knows how often Medicare pays for prefab wrist supports? My
> patient received L3923 on Dec 2017, and then L3924 on Jun. 2018, both from
> doctor’s office; now her MD asked for L3807 and I don’t know if Medicare
> pays for it after 2 years. I could not find it at the Active LCD. Any help
> would be appreciated.
>
> Regards,
> Darya Shahrokhi, CPO
>
>
Documentation Requirements Policy Article - A55426
< <URL Redacted> >.
You can find it here:
<URL Redacted>
In the Policy Article you will find replacement criteria for all orthoses.
Reasonable Useful Lifetime for all orthoses is 5 year with the exception of
knee orthoses (the knee orthoses LCD for those specifics).
REPLACEMENT
The definition of replacement is found in the CMS Benefit Policy Manual
(Internet-only manual 100-02), Chapter 15, Section 110.2.C. That section
generally defines replacement as the provision of an entirely identical or
nearly identical item when it is lost, stolen or irreparably damaged.
Beneficiary owned items or a capped rental item may be replaced in cases of
loss or irreparable damage. Irreparable damage may be due to a specific
accident or to a natural disaster (e.g., fire, flood). Contractors may
request documentation confirming details of the incident (e.g., police
report, insurance claim report).
Replacement of items due to irreparable wear takes into consideration the
Reasonable Useful Lifetime (RUL) of the item. The RUL of DME is determined
through program instructions. In the absence of program instructions,
carriers may determine the RUL, but in no case can it be less than 5 years.
If the item has been in continuous use by the beneficiary on either rental
or purchase basis for its RUL, the beneficiary may elect to obtain a
replacement.
Medicare does not cover replacement for items in the frequent and
substantial servicing payment category, oxygen equipment, or inexpensive or
routinely purchased rental items.
A treating practitioner’s order and/or new CMN, when required, is needed to
reaffirm the medical necessity of the item for replacement of an item.
*Lesleigh Sisson, CFom*
702-400-1661
This message (and any associated files) is intended only for the use of the
individual or entity to which it is addressed and may contain information
that is confidential. If you are not the intended recipient you are hereby
notified that any dissemination, copying or distribution of this message,
or files associated with this message, is strictly prohibited. If you have
received this message in error, please notify the sender immediately by
replying to the message and deleting it from your computer.
On Sun, Jun 14, 2020 at 6:57 AM Darya Shahrokhi <
<Email Address Redacted> > wrote:
> Hi all,
> Any body knows how often Medicare pays for prefab wrist supports? My
> patient received L3923 on Dec 2017, and then L3924 on Jun. 2018, both from
> doctor’s office; now her MD asked for L3807 and I don’t know if Medicare
> pays for it after 2 years. I could not find it at the Active LCD. Any help
> would be appreciated.
>
> Regards,
> Darya Shahrokhi, CPO
>
>
Citation
Lesleigh Sisson, “Re: Wrist brace frequency,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 4, 2024, https://library.drfop.org/items/show/255018.
