Medical Necessity for Feet Prostheses
Medical Necessity for Feet Prostheses: The Local Coverage Determination (LCD) L33787, outlines the medical necessity criteria for prosthetic feet.
Determining medical necessity begins by identifying the patient’s functional abilities.
Functional ability, current and potential, is established by documenting:
- Past medical history, past activities, past device use
- Current condition, current co morbidities, current limitations in mobility
- Patient’s desire to return to activities and how the prosthesis will enable that to happen
Once functional level is established, the clinician can begin choosing a foot. Based upon the K Level, the following options are available:
- K1 – L5970, L5974
- K2 – L5972, L5978
- K3 and above – L5973, L5976, L5979, L5980, L59811, L5987
What Does This Mean for You?
If the product you provide includes one of the six codes required for verification, verify correct coding on the Palmetto PDAC website. You may review any product verification and subsequent codes on PDAC’s website.
If you have further questions about PDAC verification or prior authorization requirements, contact us directly at [email protected].
Visit ossur.com for information about PDAC verified Össur feet, including the newly released Pro-Flex Modular.
You may read the entire LCD here.