To my esteemed colleagues,
I was recently asked by our local Medicaid Authorization supervisor a question regarding BK or AK prosthesis base codes that describe a prosthesis with a SACH foot and how we bill for a different foot (such as energy storing foot) when the SACH foot is not used. The question was why the payment for the base code is not reduced if we don’t use the SACH foot. I explained that the base code describes the basic prosthesis and when a different foot or other component is used the payment for that foot takes into account the amount for the SACH foot, and that it really does not accurately describe the cost of the add on foot but the difference between it and the base code foot. I was asked if there was anything in writing to describe this and I have not been able to find it in the Medicare Manual. Does anyone on the list know where that information may be hiding? She wants to explain this to her staff and have back up in case of an audit. Thanks.
Karl Entenmann, CPO
Preferred O and P
Federal Way, WA
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