In a joint publication, the Pricing, Data Analysis and Coding (PDAC) Contractor and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) addressed recent inquiries and concerns regarding the billing of additive manufacturing (i.e., 3D printing) of prosthetic devices.
“Additive manufacturing is an acceptable fabrication technique for items that are fabricated for the individual beneficiary. The correct coding for any item must meet the [Healthcare Common Procedure Coding System] (HCPCS) long description of the individual HCPCS code, along with any other published coding guidelines,” the September 18 announcement read.
The Lower Limb Prostheses Policy Article was then revised to read:
“Added: ‘Prosthetic devices (such as sockets, inserts, and applicable additions [e.g., light weight material]) that are custom fabricated for the individual beneficiary are not solely restricted to standard methods of fabrication (e.g., wet lamination and prepreg composite) and can include alternative fabrication methods (e.g., additive manufacturing). Correct coding of custom fabricated items includes compliance with the HCPCS long description of the individual HCPCS code, along with any other published coding guidelines.’ as clarification.”
To read “Additive Manufacturing Prosthetic Devices – Correct Coding,” visit the Noridian website.
To read the “LCD and Policy Article Revisions Summary,” visit the CGS website.
