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Linda Collins Blogger

Knee Bracing Before Total Joint Replacement Surgery

Posted by Linda Collins | November 12, 2015

Total Knee Arthroplasty (TKA), refers to the replacement of the knee joint. Total knee replacement is one of the most common joint replacement surgeries. The most common reason for TKA is arthritis of the knee joint.

According to the Local Coverage Determination for Lower Extremity Major Joint Replacement, Medicare will consider coverage when all the following criteria are met:

  1. X-rays or MRI indicating joint disease.
  2. Pain that interferes with activities of daily living.
  3. Three-month course of non-surgical medical management is well documented and has failed to reduce the pain.

Knee bracing is considered a possible conservative treatment modality under these guidelines.

Many private payers are following this guideline as well. Aetna requires a 12-week course of unsuccessful conservative treatment, such as bracing, that is documented in the medical record. In addition to objective diagnostic criteria, Cigna states knee replacement surgery is considered medically necessary when there is a failed course of non-surgical management, such as knee bracing.

What does this mean for you?

In order to support the medical necessity of a TKA surgery, be sure to follow the payer guidelines for conservative treatment and document the treatment modality, as well as the results.

Download the 2015 Össur OA Bracing Reimbursement Guide (also available under the Reimbursement Resources section) for more information, sample documentation language and a sample letter of medical necessity.

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If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at [email protected]