Count on Got FAQs? to help answer your toughest billing questions. This month’s column addresses replacement of a prosthesis and timing for new prior authorization rules.
Q: I recently started working for a prosthetist in Alabama. We have a patient who has had his prosthesis for six years, but it no longer properly fits him since he lost 50 pounds. I know for orthotics Medicare states how long a patient must have a brace before it can be considered for replacement. Is there anything specific Medicare mentions when it comes to replacing a prosthesis? It takes time and money to make, and I want to ensure we can get reimbursed and have all the documentation we would need. Are there any adjustments that we make for the first 90 days that we may be able to bill separately for? As always, your input is extremely helpful.