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David McGill Blogger

A Two-Fer: L5845 Audit Issue Update and HCPCS Coding Workgroup Preliminary Decisions Published

Posted by David McGill | May 15, 2017

We have a two-fer for you today.

L5845 AUDIT ISSUE

Medicare has responded to the O&P Alliance's letter requesting clarification regarding the status of the previously-published and then-removed audit issue regarding L5845 (stance flexion feature). Here's what you need to know:

  • CMS has acknowledged that "an error was made during the approval process and have determined that Issue #0049 is not viable for review by the Recovery Audit Contractor (RAC)."

What does this mean for you? 

The response from Medicare confirms that Performant, the Recovery Auditor, will not be proceeding with the L5845 audit issue at the present time. We will provide you any additional updates as they become available.


HCPCS CODING WORKGROUP UPDATE

​Medicare has published its preliminary decisions regarding new code requests for 2018. Here's what you need to know:

  • 1 application for a new prosthetic code was submitted. Medicare agreed to create a new code in response to Össur's application for its Movable Hypobaric Membrane, which can be custom-located on the Seal-In X silicone liner.
  • 5 applications for new orthotic codes were submitted. Medicare agreed to create a new off-the-shelf code in response to Ergoactives, LLC request to create a new L code for its ErgoBrace Post-Op Elbow Brace. The Coding Workgroup denied the remaining 4 requests, 3 of which were submitted by Ergoactives for, respectively a walking boot with spring-loaded shock absorbers, a post-op knee brace, and a "universal height compensator" for the sound limb for people wearing a cast, and one of which was submitted by My JAFO, LLC for the James Ankle Foot Orthotic.

What does this mean for you?

The HCPCS Coding Workgroup will host its annual Public Meeting on June 7-8 in Baltimore and will live-stream both days. The Coding Workgroup will then issue final decisions on all applications in November. Any products receiving new codes will get added to the HCPCS list in December. Pricing for the new codes could be made public at that time. Alternatively, Medicare could choose to wait until Q1 or Q2 of 2018 before publishing the allowable for any new code. 

We will keep you updated about any future developments regarding new L codes and fees as information becomes available. 

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