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Linda Collins Blogger

Walker Boots for Treatment of Diabetic Ulcers

Posted by Linda Collins | November 01, 2017

For a brace to be covered under Medicare, it must be considered medically necessary and meet the definition of a brace, as defined in the Social Security Act. For coverage under Medicare,  "the orthosis must be a rigid or semi-rigid device, which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body."

A walking boot used solely for treatment of a lower extremity ulcer or pressure reduction must be coded A9283. This is a non-covered benefit under Medicare because the brace is not being used to treat or restrict movement in a weak or deformed limb.

It is acceptable to sell the boot as a cash item and accept payment from the patient at time of delivery following these steps:

  • Give patient notice of non-coverage of the walking boot for this diagnosis
  • Ask the patient to sign an ABN type form (mandatory for Medicare Advantage plans)
  • Submit the claim with a GY modifier
  • Collect payment from the patient at time of service

For more information, read the Ankle-Foot Orthosis LCD (L33686) and Policy Article (A52457).

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