Sunday, April 2, 2023

“Frequency of services” Responses

Stephan R Manucharian

I received only one constructive and a very comprehensive response to the
following post:

Dear list,
Does anybody know whether Medicare has a regulation in respect to allowed
frequency of prosthetic services? Yes, I know all the correct phrases about
medical necessity and physical changes etc., but what I am interested to find
out is if Medicare anywhere mentions a specific time period. I hear it is 5
years in some regions. Could anyone direct me to either Medicare web-site or
any other literature with that info.

> Section 428 of the Benefits Improvement and Protection Act (BIPA)
> addresses Medicare coverage for replacement of prosthetic devices
> and parts and references a 3 year useful lifetime rule. It addressses
> only and in Region D, a 5 year useful lifetime rule continues to be in
> for orthotics.
> That does not mean Medicare will not pay if replacement is necessary
> prior to the 3 or 5 year time frame. Region D routinely requests
> supporting documenation and will pay the claim when provided such.
> The following supporting documenation is supplied when requested:
> 1. Physician Order
> 2. Delivery Acceptance Form
> 3. Clinical records of physician or orthotist/prosthetist.
> Our organization has very few problems in establishing medical necessity
> for replacemnt prior to the 3 or 5 year time frame.
> DHHS/HCFA(now CMS) transmittal AB-01_06 clarifies the issue of
> prosthetic replacements as addressed in BIPA 2000. The act actually added
> provision to the Social Security Act. The new provision is 1834
> The date of this transmittal was January 18, 2001.

Stephan R. Manucharian, CP *
Orthopedic Arts *
Brooklyn Heights, New York*

Get free e-mail and a permanent address at


Get unlimited access!

Join EDGE ADVANTAGE and unlock The O&P EDGE's vast library of archived content.


Welcome Back!

Login to your account below

Retrieve your password

Please enter your username or email address to reset your password.

The O&P EDGE Magazine
Are you sure want to unlock this post?
Unlock left : 0
Are you sure want to cancel subscription?