Saturday, December 3, 2022

Orthosis replacement policy

Gil Gulbrandson

Good morning all,
I have a Medicare patient with a knee orthosis that is no longer fitting her
properly, with profound migration to her ankle within a few steps. She clearly
needs a new design for which I have designed. The question is, the
existing orthosis is 4.5 years old. As I understand it, Medicare will not pay
for a new one inside of five years. If I document the change in limb size, can I
bill for this KO successfully…or do we have to wait for the 5 years which
comes up some time in October-November.

Thanks for you thoughts.
Gil Gulbrandson, CO,LO
Gulbrandson O&P
Cary, IL 60013

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