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DME MACs Clarify AFO/KAFO Policy

by The O&P EDGE
October 1, 2020
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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.

 

Related posts:

  1. DME MACs Clarify Requirements for A-5513
  2. Coding Verification Reviews Added for Custom AFOs
  3. DME MACs Provide Coding Definitions for OTS, Custom Orthoses
  4. DME MACs Issue Revised Coding for LIM Innovations’ Transtibial Socket
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