The Centers for Medicare & Medicaid Services(CMS) has released its 2018 fee schedule and the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have updated the Policy Article for Lower Limb Prostheses. The 2018 Policy Article becomes effective January 1.
The 2018 fee schedule provides a 1.1 percent increase over 2017. The 2018 fee schedule also includes the new Healthcare Common Procedure Coding System (HCPCS) code L-7700 describing a “gasket or seal, for use with prosthetic insert, any type, each.” Medicare’s HCPCS coding workgroup created this code in response to Össur’s application for its movable hypobaric membrane, which is used in conjunction with the Seal-In X liner, according to Össur.
The DME MACs also updated the Lower Limb Prosthesis Policy Article, which contains specific guidance about L-7700. It says, in part, “Code L-7700…describes a stand-alone (i.e., not integrated into a part of a prosthetic socket insert) sealing ring that is added to a socket insert to assist in providing or maintaining negative pressure for socket suspension…. This code is not to be used to bill for gaskets, seals, or other sealing materials that are included as part of an insert. Integrated seals are included in the code for the insert. Separate billing of integrated gaskets or seals as L-7700 is unbundling.“
To download the 2018 fee schedule, visit the CMS website.