Expansion of the CMS Master List and the Prior Authorization Program
Effective August 12, Medicare is expanding its list of Healthcare Common Procedure Coding System (HCPCS) codes for prior authorization, face-to-face...
Where Is the Custom in Custom Fabrication?
There has been a long-standing requirement, by Medicare and many other payers, that any custom-fabricated item must be supported by...
Medicare Lower Limb Prostheses Proposed Local Coverage Determination
The profession is buzzing with talk of the proposed Medicare Lower Limb Prostheses (LLP) Local Coverage Determination (LCD). The last...
Lymphedema Treatment Act: Coverage for Compression Expanded
There has been a long-standing struggle for patients diagnosed with lymphedema to receive Medicare and other payer coverage for compression...
Repairs: Why Aren’t You Getting Paid?
There is a common misconception in O&P that repair claims either aren’t paid at all or they aren’t paid adequately....
Medicare Advantage Plans: The New Rules
Have you heard the news? The Centers for Medicare & Medicaid Services (CMS) is cracking down on how Medicare Advantage...
Is It Valid? A Guide to Signatures and Addendums
It’s not uncommon for an appeal to be denied or an audit to occur based on a technicality related to...
Claim Narratives and Not Otherwise Classified Codes
Although there are other codes and circumstances that warrant the use of narratives on a claim, not otherwise classified (NOC)...
Remark Code CO-261
“The procedure or service is inconsistent with the patient’s history.” This is the message you’ll see on a Medicare Explanation...
Billing Decoded: When Can This Be Replaced? Medicare Frequency Limitations for Lower-limb Prostheses
Many of us know the struggles of the reasonable useful lifetime (RUL) and same/similar denials with orthoses when it comes...
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