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David McGill Blogger

Oh-Fer For O&P

Posted by David McGill | May 09, 2013

The Medicare HCPCS Coding Workgroup - the entity responsible for new reimbursement code creation - published its initial decisions for this year's crop of new code requests this week. The Workgroup declined to create new codes for any of the O&P submissions, listed below.

  1. Sure-Lok (upper-limb manually-controlled locking cable control system): 
    Finding - already described by L6675, L6676, or L6677 depending on level of amputation.
  2. BiOM iWalk (bionic ankle-foot device):
    Finding - already described by L5973.
  3. PFS Med TAFO (tibial ankle-foot orthosis):
    Finding - already described by L4398.
  4. Noodle AFO (carbon fiber composite ankle-foot orthosis):
    Finding - already described by L1930.
  5. Kickstart Kinetic Orthosis (hip flexion/plantar flexion assist hip-knee-ankle-foot orthosis):
    Finding - already described by L2000 plus L2200, L2250, L2780 and L2630, OR L2000 plus L2640 and L2385, OR L2000 plus L2600, depending on amputation level and whether patient is unilateral or bilateral.
  6. Bledsoe PHX Elbow Orthosis:
    Finding - already described by L3760.

What does this mean?

The next step in the code creation process is the HCPCS Coding Workgroup Public Meeting in June. At that time, the manufacturers who submitted these products for consideration will have the opportunity to contest these negative initial decisions. The HCPCS Coding Workgroup will then take the information presented under advisement and publish its final decisions in November.

In the meantime, when submitting claims to Medicare be aware that this information is a matter of public record. The DME MACs and other payers may choose to follow the Coding Workgroup's initial decisions between now and November. You should have thorough discussions internally about the potential risks and liability before billing in a manner inconsistent with these coding determinations.

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