Prosthetics - JA DME
Prosthetics
Coverage
- External Breast Prostheses Local Coverage Determination (LCD)
- External Breast Prostheses Policy Article
- Eye Prostheses Local Coverage Determination (LCD)
- Eye Prostheses Policy Article
- Facial Prostheses Local Coverage Determination (LCD)
- Facial Prostheses Policy Article
- Lower Limb Prostheses Local Coverage Determination (LCD)
- Lower Limb Prostheses Policy Article
Documentation
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Letter - Documentation of Artificial Limbs and Braces [PDF] - Letter created by the Medical Directors of all four DME MAC Jurisdictions to assist suppliers in communicating the documentation needs to the referring clinicians.
- Clinician Checklist - External Breast Prostheses [PDF] - Checklist to assist clinicians on appropriate documentation needed when prescribing prosthetics to Medicare patients
- Clinician Checklist - Lower Limb Prosthesis - Initial [PDF] - Checklist to assist clinicians on appropriate documentation needed when prescribing prosthetics to Medicare patients
- Clinician Checklist - Lower Limb Prosthesis - Replacement [PDF] - Checklist to assist clinicians on appropriate documentation needed when prescribing prosthetics to Medicare patients
- External Breast Prosthesis Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
- Lower Limb Prosthesis Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
Prior Authorization Timelines
Policy | Initial Review Decision Timeframe |
Expedited Review Decision Timeframe |
PAR Decision Valid |
---|---|---|---|
LLP | 10 business days | 2 business days | 120 days |
Tips
Topic | Details |
---|---|
Articulating Digit(s) and Prosthetic Hands - Correct Coding - Revised |
Joint DME MAC Publication for Articulating Digit(s) and Prosthetic Hands - Correct Coding - Revised |
External Breast Prostheses Bra/Camisole |
Resources |
Canceled Orders for Customized Items (salvage value) |
|
Consolidated Billing |
|
DMEPOS Payments While Inpatient |
|
External Breast Items Billed Unassigned |
|
Item Provided Prior to Surgery |
|
Prior Authorization |
|
External Breast and Lower Limb Prosthetic Refills |
|
RT/LT Modifiers |
|
Reviews/Audits
- Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
Last Updated Mon, 16 May 2022 12:58:21 +0000
Related Articles
The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.