Listserve,
Two bilateral transtibial patients that I provided K3 feet for but billed
using the modifier K2 recently got denied. Both are experienced
wearers. Clinically the K3 feet allow them to ambulate faster, more
comfortably and using less energy than any K2 feet available. I provided
the K3 feet based on the following:
“The Medicare local coverage determination (LCD) for lower limb prostheses
(L11442) effective 01-01-15 states that “It is recognized, within the
functional classification hierarchy that bilateral amputees often cannot be
strictly bound by functional level classificationâ€.
I interpret this to mean that bilateral amputees who benefit from K3
prosthetic feet should have them “covered” even though they have a K2
functional classification.
Is my interpretation incorrect? What am I missing here? Is Medicare going
back on it’s word?
Gregory M. Straub, CPO
Asheville, NC
