There is a common misconception in O&P that repair claims either aren’t paid at all or they aren’t paid adequately. As a result, suppliers do not put in the effort to document, code, and bill properly for repairs. But we should be paid for what we do, including repairs.
The first step is to understand how Medicare and similar payers define repairs: “To fix or mend, and to put back in good condition after damage or wear.” Any adjustments or repairs performed on the base item more than 90 days after delivery that are necessary to return the item to a functional status are payable. This can include the replacement of minor parts to accomplish the repair as well as labor; it would not include the replacement of major components.
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