Aside from CMS Supplier Manual verbiage, we don’t have clear criteria for
socket replacement from CMS (eg – quantified threshold for volume loss /
increases) the current audit criteria seems a bit nebulous. I was hoping
that those who have received judgements thus far would be willing to share
some of the criteria set forth by CMS to date. Specifically: Key elements
to their required CPO documentation. What did you submit? If you received a
denial – what do you think was missing? As an example, our practice has
submitted: 1) Evaluation, 2) Measurements quantifying anatomical change in
the residuum, 3) AMPro, 4) Physician Visit notes corroborating our findings.
Thanks in advance. I will share the responses.
– Mike
