Article Detail - JA DME

Repairs are covered when it’s necessary to make the orthosis functional; meaning to fix or mend and to put back in good condition after damage or wear. There must be supporting documentation for the necessity of the repair in the physician or supplier records. If the expense for the repairs exceeds the estimated expense of providing another entire orthosis, no payment will be made for the amount in excess.

A new order is not necessary when repairing a Medicare-covered item. If the base equipment was paid for by Medicare, then the required documentation is already on file, which includes timely documentation in the medical record within the past twelve months, showing that the item is being used. In the case of repairs to a beneficiary-owned AFO or KAFO, if Medicare paid for the orthosis initially, medical necessity has been established.

For a repair to be covered, the treating practitioner or supplier must document that the repair itself is reasonable and necessary, and the supplier must maintain detailed records describing the need for all repairs including a detailed explanation of the justification for any component or part replaced as well as the labor time to restore the item to its functionality.