L0637 requirements
Juan Chow LO
Description
Collection
Title:
L0637 requirements
Creator:
Juan Chow LO
Date:
3/2/2022
Text:
We've having some audits with Medicare in regards to L0637 LSO vs L0650.
I understand that not all patients require a custom fit brace and an OTS
brace would fit but some patients do require some customs modifications.
We had to request a call from Medicare since for months all they do is
deny without a reason. When we stated that they must also provide
education as stated by the auditing company finally we got a call.
Basically it went the same way, stating that you have to say why the
modifications were needed. When I asked her about the modifications that
we have done, such as hyper/hypo lordosis, pendulum abdomen, scoliosis
etc. Basically she stated that all those modifications, such a shaping
plastic panels with a heat gun, the patient or anybody without
education is able do them and thus do not require a custom fit. I asked
her to then give me an example of what modifications would be consider a
custom fit and she could only come with modifications for a colostomy
bag for example. The only modification for a colostomy bag I would
assume would be to make a hole in the brace which in turn voids the
warranty from the manufacturer. Essentially the education message was to
read the requirements. Does anybody know what exactly counts for these
custom modifications? Since we are in a competitive bid area and we are
not in the list we essentially have to evaluate the patient and
determine is they really, really need a custom fit, if the patient
doesn't then I have to tell them that they wasted their time and mine
time and I have to tell them to go somewhere else. I guess I'm just venting.
Juan Chow LO
I understand that not all patients require a custom fit brace and an OTS
brace would fit but some patients do require some customs modifications.
We had to request a call from Medicare since for months all they do is
deny without a reason. When we stated that they must also provide
education as stated by the auditing company finally we got a call.
Basically it went the same way, stating that you have to say why the
modifications were needed. When I asked her about the modifications that
we have done, such as hyper/hypo lordosis, pendulum abdomen, scoliosis
etc. Basically she stated that all those modifications, such a shaping
plastic panels with a heat gun, the patient or anybody without
education is able do them and thus do not require a custom fit. I asked
her to then give me an example of what modifications would be consider a
custom fit and she could only come with modifications for a colostomy
bag for example. The only modification for a colostomy bag I would
assume would be to make a hole in the brace which in turn voids the
warranty from the manufacturer. Essentially the education message was to
read the requirements. Does anybody know what exactly counts for these
custom modifications? Since we are in a competitive bid area and we are
not in the list we essentially have to evaluate the patient and
determine is they really, really need a custom fit, if the patient
doesn't then I have to tell them that they wasted their time and mine
time and I have to tell them to go somewhere else. I guess I'm just venting.
Juan Chow LO
Citation
Juan Chow LO, “L0637 requirements,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/255825.
