Looking for some advice from fellow Wisconsin practitioners or anyone who has dealt with ForwardHealth. I have a 21 year old BK patient who has been in his preparatory prosthesis for 1 year now, currently wearing 15 ply of sock even with multiple pads in the socket. We were looking to get him his definitive prosthesis, but currently they are denying 7 L-Codes, because I am using them again before the end of their 5 year life expectancy. They denied the following:
Flexible Inner Socket
Flex Foot Walk System.
I couldn’t even do a socket replacement without using a majority of those codes, so I am not sure what ForwardHealth would like me to build the patient. Has anyone had success appealing this, what’s the process like?