Article Detail - JA DME
Obtaining Prior Authorization for Bilateral Orthoses
Prior authorization requests for bilateral orthoses can be submitted on the same request. This need can be specified in the order by indicating a quantity of two, specifying right and left sides, or through medical record documentation indicating the necessity for two orthoses. However, the documentation of medical necessity must justify the requirement for bilateral braces.
Upon submission of a prior authorization request for bilateral braces, the supplier will receive two unique tracking numbers (UTNs).
The only exception to this is when a supplier is submitting a prior authorization request for bilateral mirror HCPCS codes, as the type of fitting needed at delivery may be unknown. In such cases, the supplier must submit separate prior authorization requests for each mirror code. For example, one request for bilateral L1851 and another for bilateral L1843.
