Wednesday, April 24, 2024

Medicare Policy in LCD & Articles

Occasionally someone asks a question about Medicare policy, some of those questions can be answered by reading Medicare Local Coverage Determination policies and Articles which can all be viewed online. If you’ve signed up to receive email from your DME/MAC carrier you’ll automatically receive notices about new policies or updates to current polcies otherwise you should check the CMS LCD/Articles site periodically for updates:

National Coverage contains general medical policy, not much pertaining to O&P but I saw one NCD “Corset Used as Hernia Support” which is probably relevant today.

Most of the stuff O&P practitioners need are under Local Coverage, you must review both LCD and Articles to completely grasp current Medicare policies.

One way to find your area’s policy is to select LCD (Local Coverage Determination), then by state and select your state, then select your current DME/MAC carrier. You should see a list of Local Coverage Determination policies which can be sorted various ways (alphabetical, effective date). The list contains DME policy too so you’ll have to sift through the list.

After you’ve saved/printed all your O&P LCD policies return to the page where you selected LCD but this time select Articles, then select state and your current DME/MAC carrier. You should see a list of Articles, some pertain to O&P but you’ll also find articles about Valid Detailed Orders, Who Can Sign an Order, Backup Equipment, etc. These articles contain policy or policy clarification. Read all articles pertaining to your business to completely grasp current Medicare policy. Sometimes two articles are needed to clarify a policy, for instance:

policy regarding Reasonable Useful Lifetime of an orthosis is found in article A36043 “Orthosis Billing Reminders” and policy regarding reasonable useful lifetime of prefab knee orthoses is found in article A47270 “Knee Orthoses”.

Pat Owen
Office Manager, Ryder Orthopaedics


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