The Centers for Medicare & Medicaid Services (CMS) has extended coverage to allow K2-level users of lower-limb prostheses access to microprocessor-controlled prosthetic knees (MPKs). The posting of the final Local Coverage Determination (LCD) marks the beginning of the 45-day notice period; it goes into effect for claims with dates of service on or after September 1.
The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) published the final LCD and LCD-related Policy Article (PA) titled Lower Limb Prostheses LCD (L33787) and LCD-related PA (A52496).
The LCD incorporates finalized revisions as a result of the LCD reconsideration process and written comments received during the comment period for the proposed LCD. The final LCD modifies the coverage criteria for MPKs to include coverage for Medicare Functional Classification Level (MFCL) 2 (K2) beneficiaries.
The LCD modifies the coverage criteria for prosthetic feet in order to allow coverage of a compatible foot when coverage criteria for an MPK are met; adds GA, GY, GZ, and KX modifiers to the Coding Information section of the LCD; and adds Healthcare Common Procedure Coding System (HCPCS) code L-5841 to the coverage criteria for fluid and pneumatic knees.
The DME MACs also published a Response to Comments article, which addresses the written comments received during the comment period.
“The decision by US Medicare to allow for extended coverage creates a pathway for K2 transfemoral amputees to utilize more functional knee and foot solutions than they have historically had access to,” Sveinn Sölvason, president and CEO of Embla Medical, said in response to the new LCD. “This is great news for active K2 lower-limb amputees as they account for a large part of the overall amputee population. We welcome this decision, which we believe will hugely improve these individuals’ lives, helping them become more active and able to perform critical activities of daily living more independently.”
To read the joint publication, visit the CGS or Noridian websites.
To read the policy article, visit A52496 – Lower Limb Prostheses – Policy Article.
To read the response to the comments, visit A59857 – Response to Comments: Lower Limb Prostheses – DL33787.
