The DME MAC Jurisdiction A has completed the widespread prepayment review of claims for Lumbar-Sacral Orthoses (HCPCS codes L0631 and L0637). These findings include claims processed primarily from March 2015 through May 2015. The review involved prepayment complex medical review… Read More ›
DME Coding
Knee Orthosis (HCPCS L1832, L1843) Quarterly Results of Service Specific Prepayment Review
The Jurisdiction D, DME MAC, Medical Review Department is conducting a service specific review of HCPCS code(s) L1832 and L1843. The quarterly edit effectiveness results from January 2015 through April 2015 are as follows: The L1832 review involved 89 claims,… Read More ›
CORRECT CODING – DEFINITIONS USED FOR OFF-THE-SHELF VERSUS CUSTOM-FITTED PREFABRICATED ORTHOTICS (BRACES) – REVISED
Joint DME MAC Publication This is a revision to a previously published article 3/28/2014. As part of the 2014 and 2015 HCPCS update, codes were created describing certain OTS orthotics. Some of these codes parallel codes for custom fitted versions… Read More ›
Widespread Prepayment Probe for HCPCS Code L4360 (Pneumatic Walking Boot)
DME MAC A will be initiating a widespread prepayment probe of claims for the following HCPCS code: L4360 (WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED,… Read More ›
Split Coding…..have you adjusted?
We recently passed the one year mark of the roll-out of CMS’s changes to HCPCS coding for orthotics. If you have been tracking this issue, you know that CMS made significant changes to the coding structure by establishing two separate… Read More ›
2015 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
For CY 2015, the update factor of 1.5 percent is applied to the applicable CY 2014 DMEPOS fee schedule amounts. For more information and to download the 2015 DMEPOS Fee Schedule please click these links: CMS Transmittal 3129 … Read More ›
Two new off-the-shelf (OTS) knee orthosis codes are effective today October 1, 2014:
The following two new off-the-shelf (OTS) knee orthosis codes are effective today October 1, 2014: K0901 KO Single Upright Pre OTS Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension… Read More ›
Ankle-Foot Orthoses: Walking Boots – Coverage and Coding Issues – Revised
HCPCS codes L4360, L4361, L4386 and L4387 describe an ankle-foot orthosis commonly referred to as a walking boot. Walking boots that are used to provide immobilization as treatment for an orthopedic condition or following orthopedic surgery are eligible for coverage under the… Read More ›
New Off-The-Shelf Knee Orthosis Codes
Today CMS posted its quarterly HCPCS update, which includes the following two new off-the-shelf (OTS) knee orthosis codes, effective October 1, 2014: K0901 KO Single Upright Pre OTS Knee orthosis (KO), single upright, thigh… Read More ›
Revised Local Coverage Determination (LCD) for Knee Orthoses (L27263)
A knee immobilizer without joints (L1830), or a knee orthosis with adjustable knee joints (L1832, L1833), or a knee orthosis, with an adjustable flexion and extension joint that provides both medial-lateral and rotation control (L1843, L1845), are covered if the… Read More ›
