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Linda Collins Blogger

One, Two….

Posted by Linda Collins | October 01, 2013

We have recently received scattered feedback that Medicare – in particularly, MAC Region D - is denying prosthetic claims that include a second liner, stating that only one is medically necessary.

So long as your records detail the need for two liners, the LCD for lower limb prosthetics explicitly permits it:

No more than two of the same socket inserts (L5654-L5665, L5673, L5679, L5681, L5683) are allowed per individual prosthesis at the same time.

During Region D’s recent “Ask the Contractor” teleconference, this topic came up at some length. While the MACs and Medicare look into the situation, make sure that (a) your records fully and completely detail the patient’s medical need for two liners, and (b) if you do get a denial for two liners, immediately request a re-determination and include a copy of the LCD for your Region in the appeal.

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