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Linda Collins Blogger

Orthotics Delivered to a Hospital or SNF

Posted by Linda Collins | November 15, 2017

You deliver a back brace to a patient in the hospital. You deliver an AFO to a patient in a SNF. If you submit a claim to Medicare, will you get paid? That is a common question that can typically be answered by the "48-hour rule."

According to Medicare, all orthotic devices are to be used by a patient in a home setting. (A hospital or SNF do not qualify as a patient's home unless the patient has resided there longer than 100 days.)

To bill for the brace, the following conditions must be met:

  • Orthosis is prescribed for use at home and will not be used in the facility.
  • The brace is medically necessary on the date of discharge and the physician's notes corroborate this.
  • You deliver the brace no more than two days/48 hours prior to discharge of the patient.
  • The date of discharge is the date of service on your claim.

If a brace is prescribed for the patient's use in a facility (i.e. hospital or SNF) then the facility is financially responsible for the brace.

More information about this policy may be found in the Internet Only Medicare Claims Processing Manual Chapter 20 (download here), Internet Only Medicare Claims Processing Manual, Chapter 15 (download here), and the Internet Only Medicare Program Integrity Manual (download here). A summary of the 48-hour rule can be found here.

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