Thursday, May 26, 2022

Re: New Medicare Prosthetic Coverage Requirements?

Karl Entenmann

The question here is whether the prosthesis codes are still exempt from SNF pps billing. As I understood in the past, specific codes were exempt from pps and this checklist appears to say the opposite. I believe there were issues about a prosthesis being fitted in the hospital under Medicare part A, but that in an SNF, those specific codes were exempt from pps billing and we could in the past bill CMS for those codes (prep or definitive prosthesis) even during the part A stay. AOPA needs to clarify this because I believe it is in error.
Karl Entenmann, CPO
Preferred O and P
Federal Way, Wa

Sent from my iPad

On Jan 21, 2013, at 12:06 PM, “Brett R. Saunders, CPO, FAAOP” wrote:

> CGS Medicare has published a new Prosthetic Documentation Checklist and if I read this correctly,
>
> Prosthetic devices can only be delivered to patients in SNF units if:
>
> 1 It will be medically necessary after discharge, AND
> 2 Is fit and delivered within 2 days of discharge from the SNF, AND
> 3 Is NOT needed for inpatient treatment or rehabilitation.
>
> Is this a new change in policy on coverage for prosthetics??
>
> The document I am referencing is found at cgsmedicare.com/jc/coverage/mr/PDF/MR_checklist_LLP.pdf
>
> How could a prosthesis NOT be considered as needed for inpatient treatment and rehabilitation?
>
>
> Brett R. Saunders, CPO, FAAOP
>
>
> ********************
> To unsubscribe, send a message to: [email protected] with
> the words UNSUB OANDP-L in the body of the
> message.
>
> If you have a problem unsubscribing,or have other
> questions, send e-mail to the moderator
> Paul E. Prusakowski,CPO at [email protected]
>
> OANDP-L is a forum for the discussion of topics
> related to Orthotics and Prosthetics.
>
> Public commercial postings are forbidden. Responses to inquiries
> should not be sent to the entire oandp-l list. Professional credentials
> or affiliations should be used in all communications.

Sent from my iPad

On Jan 21, 2013, at 12:06 PM, “Brett R. Saunders, CPO, FAAOP” wrote:

> CGS Medicare has published a new Prosthetic Documentation Checklist and if I read this correctly,
>
> Prosthetic devices can only be delivered to patients in SNF units if:
>
> 1 It will be medically necessary after discharge, AND
> 2 Is fit and delivered within 2 days of discharge from the SNF, AND
> 3 Is NOT needed for inpatient treatment or rehabilitation.
>
> Is this a new change in policy on coverage for prosthetics??
>
> The document I am referencing is found at cgsmedicare.com/jc/coverage/mr/PDF/MR_checklist_LLP.pdf
>
> How could a prosthesis NOT be considered as needed for inpatient treatment and rehabilitation?
>
>
> Brett R. Saunders, CPO, FAAOP
>
>
> ********************
> To unsubscribe, send a message to: [email protected] with
> the words UNSUB OANDP-L in the body of the
> message.
>
> If you have a problem unsubscribing,or have other
> questions, send e-mail to the moderator
> Paul E. Prusakowski,CPO at [email protected]
>
> OANDP-L is a forum for the discussion of topics
> related to Orthotics and Prosthetics.
>
> Public commercial postings are forbidden. Responses to inquiries
> should not be sent to the entire oandp-l list. Professional credentials
> or affiliations should be used in all communications.

RECENT NEWS

Get unlimited access!

Join EDGE ADVANTAGE and unlock The O&P EDGE's vast library of archived content.

O&P JOBS

Welcome Back!

Login to your account below

Retrieve your password

Please enter your username or email address to reset your password.

The O&P EDGE Magazine
Are you sure want to unlock this post?
Unlock left : 0
Are you sure want to cancel subscription?