Medicare denials for L5673 & L5679

Cindy Anderson

Hi All,

Medicare has been denying L5673 & L5679 when billed as replacements. Has anyone else experienced this problem? As I understand it they can be replaced under the original prescription, no doctor order required, which means no doctors records stating why they have to be replaced. We were told during a webinar that one liner could be provided while a new socket/prosthesis was being replaced, and two more were billable with the new prosthesis so I don’t know why all the denials.

I was told to file a redetermination and wondered what information I should provide other than the liners were torn and beyond warranty?

Cindy Anderson
Manfredi O&P
cindyanderson-2@comcast.net

 

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