Coding Guidance for 3D Printed Devices

What You Need to Know

The DME MACs and PDAC recently released new joint guidance confirming that Medicare considers additive manufacturing an acceptable fabrication method for prosthetic devices:

• "Additive manufacturing is an acceptable fabrication technique for items that are fabricated for the individual beneficiary."
• "The correct coding for any item must meet the HCPCS long description of the individual HCPCS code, along with any other published coding guidelines."

This brings the standards for 3D printed prosthetic devices in line with those for custom-fabricated orthoses. That guidance, published in early 2024, confirmed that "additive manufacturing is an acceptable custom fabrication technique [for orthoses] as long as it adheres to the CMS DMEPOS Quality Standards, Appendix C."

Consistent with the new coding guidance, the Lower Limb Prostheses Policy Article has been updated with the following language:

"Prosthetic devices (such as sockets, inserts, and applicable additions [e.g., light weight material]) that are custom fabricated for the individual beneficiary are not solely restricted to standard methods of fabrication (e.g., wet lamination and prepreg composite) and can include alternative fabrication methods (e.g., additive manufacturing). Correct coding of custom fabricated items includes compliance with the HCPCS long description of the individual HCPCS code, along with any other published coding guidelines." [emphasis added]

What This Means for You

If you are:

• Using additive manufacturing to fabricate prosthetic devices, or
• Using a third-party service that does so,

this guidance confirms Medicare's acceptance of that method as valid and reimbursable.

 Importantly, CMS has concluded that existing HCPCS code long descriptors apply to 3D printing. This means you should use existing codes when billing for devices fabricated via additive manufacturing.