Wednesday, December 7, 2022

Medicare and Static AFOs

Jim Thelen

I am seeing a 51 yo male C-4 quad who has been wearing PRAFO style afo’s for
many years for positioning and foot ulcer management and control. He is a
new patients to us and needs replacement afo’s. I know the previous
fittings were billed to medicare and paid but I am not aware of how they
were billed.

Medicare states in their LCD for AFO’s: [quote] “Medicare does not reimburse
for a foot drop splint/recumbent positioning device (L4398) or replacement
interface (L4394). A foot drop splint/recumbent positioning device and
replacement interface will be denied as not medically necessary in a patient
with foot drop who is nonambulatory because there are other more appropriate
treatment modalities.”

My question is: What are the “other more appropriate treatment modalities”?

Jim Thelen, CP, BOCO, LPO

Trinidad Medical Consultants

Dallas, TX

214-340-6200

Fax 214-340-2206

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