Thursday, July 25, 2024

L5679 Denial? (Responses)

Jim Sedlak

Below is my original inquiry followed by the responses that I received. Thanks to all that responded.

Jim Sedlak, CP

I received a denial for frequency on L5679 after providing a new set of liners after 10 months. I am sure this has been covered on the board several times before, so I apologize for asking again. However, I need help with this. How do I fight this as the liners were needed? Also, is there a search function on OandP.com that I can utilize before asking the same question that has been asked before?

TIA
Jim Sedlak, CP

Responses

Aren’t they not still under warranty?

If you have great physician documentation of the need for replacement you can appeal. Cms is 12 months plus one day. Similar issue for prep leg then definitive within 12 mo. I only provide one liner for preps.

We’ve been dealing with these liner denial for 3-4 years now. You’re not likely to get Medicare to overturn their denial, we’ve tried.

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