We’re in Region B and transitioned this year to CGS from NGS Medicare. I’m currently dealing with a rejection of L5647 – Below Knee Suction Socket. Denial was for lack of medical necessity. As the Lower Extremity Prosthetic LCD does not have any mention of this code outside of its exclusion from use on a preparatory prosthesis, I’m wondering if anyone can enlighten me as to what sort of Medical Necessity guideline CGS utilizes when there is nothing in CMS policy or the LCD.
Thank you in advance,
Ted A Trower CPO
A-S-C Orthotics & Prosthetics
1407 E Michigan Ave.
Jackson, MI 49202
517-784-1142
