The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and Pricing, Data Analysis and Coding (PDAC) contractor have retired the Upper Limb Prostheses-Correct Coding guidance published in March 2022. The document now reads, “This publication is retired pending the future development of new or revised [Healthcare Common Procedure Coding System] codes.”
In an announcement about the withdrawal, the American Orthotic and Prosthetic Association (AOPA) said that the document “resulted in significant concern from AOPA and its partners in the O&P Alliance about the impact the correct coding guidance was having on access to clinically appropriate, medically necessary upper-extremity prosthetic care, not only for Medicare beneficiaries but also for individuals covered by other insurers who adopted the correct coding guidance into their own policy decisions.”
The O&P Alliance submitted written comments regarding its concerns about the publication, had follow-up communications, and met with representatives at the Centers for Medicare & Medicaid Services, the DME MACs, and the PDAC contractor.
“The DME MAC and PDAC medical directors indicated that the intention of all correct coding guidance is to assist providers in understanding how to properly describe the services they are providing and explained that their guidance is never meant to create new or revised coverage policy. The medical directors suggested that they would consider retiring the correct coding guidance if it was creating more confusion than clarification for providers and beneficiaries alike,” AOPA said in its statement. “This extremely positive development shows the incredible value of open and trusted communication.”
To read the original document, visit Upper Limb Prostheses-Correct Coding on the Noridian website.
To read the statement from NAAOP or to see its webcast, visit “NAAOP Webcast: Upper-limb Coding Retired, Wheelchair Seat Elevation Coverage.”
