PDAC Required Verification for 6 L-Codes, Continued

The Issue

We have gotten multiple questions from individuals confused about the recently-announced PDAC-required verification for 6 lower-extremity prosthetic L-codes. The questions center on a reference in some articles about this topic to an August 1 effective date.

Here's what you need to know:

1. In addition to the Local Coverage Determination, the DME MAC's also publish an accompanying Policy Article. The LCD and the Policy Article together describe all relevant coding and coverage requirements for lower limb prostheses.
2. The publications causing confusion note that the DME MAC's are issuing an updated Policy Article with an effective data of August 1, 2020. 
3. The August 1, 2020 reference is not a deadline associated with coding verifications for the 6 L-codes referenced in the DME MAC's announcement. The Policy Article has been updated for the sole purpose of stating that for all claims that include L5856, L5857, L5858, L5973, L5980 and L5987 submitted on/after Jan. 1, 2021, Medicare will only pay for knees/feet described by those codes if the products have undergone PDAC coding verification.

What does this mean for you?

Nothing. The only thing happening on August 1 is that the Policy Article accompanying the Lower Limb Prostheses LCD is being updated. The revised Policy Article merely incorporates what the DME MAC's already announced - beginning on Jan. 1, 2021, Medicare will not approve claims that include any of the aforementioned L-codes unless the products accompanying those L-codes have been PDAC-verified.

We will keep you apprised of any further developments regarding this topic as events warrant.