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Linda Collins Blogger

Replacing a Socket

Posted by Linda Collins | September 15, 2015

How often can you bill for a new socket? What documentation is required to justify a socket replacement? These are common questions and the answers are found in the Local Coverage Decisions (LCDs.)

The LCDs for Lower Limb Prostheses indicate a socket replacement may be considered medically necessary when:

There is a documented change in the patient's physiological condition such as weight gain or loss, changes in the residual limb or changes in the patient's functional level.

OR

The socket is broken beyond repair.

A replacement socket requires a new Detailed Written Order (DWO) and physician medical records which explain the reason for replacement. The prosthetist must also document the reason for replacement in the patient's medical record. It is important to be specific and detailed about the reason for replacement. Photographs of the broken or ill-fitting socket may be beneficial to support the need. (NOTE: If you do take photographs, be sure to identify the patient and date on the back.)

As is the case with all prostheses, the right (RT) and left (LT) modifiers must be used on the claim.

The LCDs for Lower Limb Prostheses can be found through the following links:

Region A, NHIC, LCD

Region B, NGS, LCD

Region C, CGS, LCD

Region D, Noridian, LCD

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