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David McGill Blogger

Trick Question: What's the RUL for Prosthetic Devices?

Posted by David McGill | October 21, 2014

O&P's often believe that prosthetic components have a reasonable useful lifetime. We receive emails from customers at least once a quarter bemoaning the fact that prostheses have a 5-year RUL. 

They do not! ("What? Did I read that correctly?" Yes, you did - no RUL for prosthetics.)

Where does it say that? In a federal law, that's where:

Payment shall be made for ... artificial limbs, or for the replacement of any part of such devices, without regard to continuous use or useful lifetime restrictions if an ordering physician determines that [it is] necessary because of any of the following:

(I) a change in the physiological condition of the patient.

(II) An irreparable change in the condition of the device, or in a part of the device.

(III) The condition of the device, or the part of the device, requires repairs and the cost of such repairs would be more than 60 percent of the cost of the replacement device, or, as the case may be, of the part being replaced. [emphasis added]*

What does this mean for you?

When it comes to prosthetic components, you are not bound by reasonable useful lifetime requirements. Rather, you have to show that the patient or product's condition has changed, or that the cost of repairs would be more than 60% of the device's cost. Like all prosthetic claims submitted to Medicare, you should make sure that a physician specifically identifies one of these reasons in his records to maximize your chance of a successful claim outcome.

Go bravely into the future secure in the knowledge that prosthetic component claims fall outside the realm of reasonable useful life restrictions. And if you're interested in RUL's for certain orthotic products, click here to see our post from earlier this year on the topic.

*Section 1834 of the Social Security Act (21)(h)(G).

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