I have a new T/F amputee, strong microprocessor candidate with Amp-nopro score of 31/39. Aetna has denied the microprocessor code in our pre-auth stating that they cover these knees for trauma and cancer patients but not vascular amputees. We are gearing up with the physician for the initial peer-to-peer review/redetermination. Has anyone run into this situation and if so, were you able to succeed in getting the knee covered? I’m trying to get all our ducks in a row prior to setting this call up….studies, patient activities, etc.
Thanks in advance
Chris Phillips, CPO
Seacoast Orthotics and Prosthetics
155 Griffin Road Unit 2
Portsmouth, NH 03801
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