The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) released a revised AFO/KAFO Policy Article clarifying the custom fabrication language.
The revision includes the following:
“If the item is custom fabricated and does not have a specific HCPCS code, a complete and clear description of the item, including what makes this item unique, and a breakdown of charges (material and labor used in fabrication) should be entered in the narrative field of an electronic claim or on Item 19 of a paper claim. (Refer to the LCD-related Standard Documentation Requirements article (A55426) for more information regarding billing of items with HCPCS codes that include miscellaneous, NOC, unlisted, or non-specified in their narrative descriptions.)”
The original language said:
“In addition, if the item is custom fabricated, a complete and clear description of the item, including what makes this item unique, and a breakdown of charges (material and labor used in fabrication). This information should be entered in the narrative field of an electronic claim.”
The revised AFO/KAFO Policy Article is effective October 1.
To read the revised article, visit the CMS website.
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