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David McGill Blogger

New L Code, Fee Schedule and Policy Article For 2018

Posted by David McGill | December 22, 2017

CMS has released the 2018 fee schedule and the DME MACs have updated the Policy Article for Lower Limb Prostheses. Here's what you need to know:​

  1. The 2018 fee schedule provides a 1.1% increase over the 2017 fee schedule.

  2. The 2018 fee schedule also includes L7700, a new code describing a "gasket or seal, for use with prosthetic insert, any type, each." Medicare's HCPCS Coding Workgroup created this code in response to Össur's application for its movable hypobaric membrane, which is used in conjunction with the Seal-In X liner. L7700 has a Medicare ceiling of $145.49 and a floor of $109.12.

  3. The DME MACs also updated the Lower Limb Prosthesis Policy Article, which contains specific guidance about L7700. It says, in relevant part, "Code L7700 ... describes a stand-alone (i.e., not integrated into a part of a prosthetic socket insert) sealing ring that is added to a socket insert to assist in providing or maintaining negative pressure for socket suspension. ... This code is not to be used to bill for gaskets, seals, or other sealing materials that are included as part of an insert. Integrated seals are included in the code for the insert. Separate billing of integrated gaskets or seals as L7700 is unbundling." [emphasis added]

What does this mean for you?

The 2018 fee schedule update affects both your Medicare reimbursement and, if your private insurance contracts are tied to Medicare rates, your private insurance reimbursement as well. You should be reviewing those contracts to assess the impact of the 1.1% fee schedule increase on your business as a whole. You can download the 2018 fee schedule here.

In addition, the Policy Article guidance regarding L7700 is something you must understand and comply with. The DME MACs consider billing L7700 for seals that are integrated into the liner - i.e., fixed in one place - unbundling. So make sure that you only use this code, when utilizing a seal that isn't permanently affixed to the liner and is movable. The 2018 Policy Article becomes effective on January 1st. You can access it if you are an AOPA Member by visiting the AOPA Co-OP here, or by visiting your DME MAC website and searching for the Lower Limb Prostheses future Policy Article. 

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