AV - JA DME

Item furnished in conjunction with a prosthetic device, prosthetic or orthotic

Correct Use

The HCPCS codes indicated below are the only codes for which the AV modifier may be used. No other HCPCS codes require the use of the AV modifier when billing.

• Facial Prosthesis Local Coverage Determination (LCD)
  • A4450
  • A4452
  • A5120

Any claims submitted with a HCPCS identified above that does not have the appropriate modifier appended as per the policy with which it is billed, will be denied as noncovered.

Resources

• Active Local Coverage Determinations (LCDs) - Facial Prosthesis
• Supplier Manual