The Centers for Medicare & Medicaid Services (CMS) has revised the Medicare Learning Network MLN Matters Special Edition Article SE1213, “Questionable Billing by Suppliers of Lower Limb Prostheses,” to delete a note that previously allowed a prosthesis to be replaced without a physician order so long as the device was not being upgraded. The revision is effective April 13, 2013.
The deleted statement reads, “If a supplier is replacing an old prosthesis and there is no upgrade in the model, the supplier does not need a physician order. Also, the ‘ordering’ physician need not be a surgeon and may be the beneficiary’s primary care physician.” It was originally added to SE1213 in a June 7, 2012 revision.
To read the 2013 revision, click here. To read the 2012 revision, click here.
