Suppliers are required to correctly code for the item billed. Pursuant to 42 CFR §§ 414.40 and 45 CFR §§ 162.1002, CMS has the authority to assign and manage HCPCS codes (create, delete, change code narrative etc.).Ĭorrect HCPCS coding is a determination that the item provided to a beneficiary is billed using the appropriate HCPCS code.
SIZEWISE PDAC LETTER MANUAL
The CMS Internet Only Manual (IOM), Publication 100-08, PIM, Chapter 3, Sections 3.3.B and 3.6.2.4 specify that for Medicare claims, only the CMS and the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have the authority to establish HCPCS Level II Coding Guidelines. L1851 - Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf L1833 - Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf L1832 - Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0650 - Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf Lower Limb Orthoses (Knee Orthoses): L0648 - Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf 9, 2051-2058.) Within the list of L-codes, two lumbar sacral orthoses codes and three lower limb orthoses codes are scheduled for implementation: Lumbar Sacral Orthoses:
Recently CMS published updates to the Master List and the selection of certain lower limb orthoses and lumbar sacral orthoses were added to the Required Prior Authorization List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items that require prior authorization as a condition of payment ( Federal Register / Vol.
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