At the request of the Centers for Medicare & Medicaid Services (CMS), the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have proposed changes to the Local Coverage Determination (LCD) for lower-limb prostheses (DL33787). The proposal would give some K2-level users access to devices that have been limited to K3 users.
CMS and the DME MACs are soliciting comments on the proposed LCD from stakeholders, including, but not limited to, clinicians, manufacturers, suppliers, and other parties who care for Medicare beneficiaries. Comments must be submitted comments electronically no later than March 2. The DME MACs will host a virtual open meeting on February 22 to further solicit input.
The suggestions from the DME MAC, identified as LCD DL33787, are described as follows:
- Proposing modifications to the coverage criteria for microprocessor-controlled prosthetic knees (MPKs), to include coverage for Medicare Functional Classification Level (MFCL) 2 beneficiaries with lower-limb amputations who require a prosthetic knee; proposing modifications to the coverage criteria for prosthetic feet in order to allow coverage of a compatible foot when coverage criteria for an MPK are met; proposing addition of GA, GY, GZ, and KX modifiers to the Coding Information section of the LCD.
Comments should be very specific and, if possible, offer suggestions that may address concerns with the LCD. Commenters should include evidence-based rationale and attach any full-text references from the published clinical literature (for example, peer-reviewed journals, clinical society guidelines, etc.) that were not included in the bibliography of the proposed LCD. Comments must disclose all conflicts of interest with any manufacturer(s) or supplier(s) of the Durable Medical Equipment, Prostheses, Orthoses, and Supplies items addressed in the proposed LCD.
CMS cautioned suppliers and clinicians not to make any changes based upon information contained in the proposed LCD as it may be revised based upon the written comments received during the comment period.
For details regarding participation in the virtual open meeting, refer to the open meeting announcement article posted at Open Meeting Announcement – Lower Limb Prostheses Proposed Local Coverage Determination. Refer to each DME MAC website for additional information, including access to the proposed LCD.
To read the details of the proposed LCD posted on the Medicare Coverage Database, reference the LCD ID number in the search field. The entire proposed LCD should be reviewed prior to submission of written comments.
To submit comments, email LLPLCDCOMMENTS@cgsadmin.com.
