The Centers for Medicare & Medicaid Services (CMS) has posted revisions to the coding of lower-limb prostheses in Jurisdiction A, which includes Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. The Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for Jurisdiction A posted the revisions to the Local Coverage Determination (LCD) and Policy Article (PA) on February 25, 2009. A summary of the revisions is listed below. To view the complete LCD and PA, visit www.medicarenhic.com/dme/medical_review/mr_lcd_current.shtml
LCD
- Revision Effective Date: January 1, 2010
- Indications and limitations of coverage added: Functional level requirement for L-5973.
- HCPCS codes and modifiers added: L-5973
- Documentation requirements deleted: Outdated instruction for code L-5930.
Policy Article
- Revision Effective Date: April 1, 2010
- Revised: Instructions for use of code L-7520.
- Deleted: Instructions for use of RP modifier.
- Revised: Instructions for use of ultralight component codes L-5940-L-5960.
- Added: Statement concerning rejection of claims without an RT or LT modifier.
