Hello Colleagues and Guests,
As I was going over some old “stuff” the other day, I noticed an old fee
schedule that we had prepared back in 2006. I glanced through it briefly
and then went back to see what L0631 looked like back then. Over the
years, I have seen a degradation of LCode descriptive nomenclature and,
quite frankly, have always been puzzled by it. Now, I am beginning to
see the light. We as practitioners have rarely had any serious input
into what Lcode changes were occurring and the logic behind such
changes. That has always been controlled by CMS and their appointed
consultants/committees. As a result of some of these changes, Pandora’s
box has been unleashed on the public at large and now the Medicare
system (we the taxpayer) has paid the price. Let me illustrate. In 2006,
L0631 was a custom fabricated device with an allowable to reflect the
differences in measuring, fabricating, and fitting costs compared with a
prefabricated device. Now L0631 is a prefabricated device, but the
allowable is still the same as though it were custom fabricated. Who the
responsible parties were for making this change remains to be seen, but
I believe it clearly illustrates problems within the CMS system. Another
example would be L0639. This is a prefabricated device. As far as I can
tell, L0640 is a similar device that is custom fabricated. However, the
allowable fee for the prefabricated device is approximately 20% higher
than for the custom fabricated unit. Where is the explanation or logic
for this? Has anyone compared L1005 to L1000? Here again we are
comparing a custom fabricated device (and a fairly complex one at that I
might add if it is done right) to a prefabricated device. The point I am
trying to make is this. We, as orthotists and prosthetists must get
involved to help upright a sinking ship. If we continue to allow others,
who are sometimes uninformed to say the least, to control our
professional destiny, shame on us. So let’s all get more involved while
there is still time.
I have not given a description of the codes and hope that you will look
them up for yourselves. That does not seem like it should be a problem
for most interested folks. But I know it ticks off a few. So be it.
Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123
