Retired - Correct Coding – LIM Innovations Infinite Socket™
Joint DME MAC Publication
LIM innovations Infinite Socket™ TF C1 is a prefabricated modular above-knee design that has recently become available. This product uses four struts that extend from the base to an adjustable brim to form the structure of the item.
The existing HCPCS L-codes used for above-knee lower limb prosthesis sockets describe items which enclose the residual limb to provide the stability, proprioception, and suspension necessary for the effective use of the artificial limb. This product is sufficiently different in design and construction that existing L-codes for sockets and socket additions are inappropriate for use with this product. Claims for this item using existing L-codes will be denied as incorrect coding
As a defined-benefit program, the first requirement for any item to be potentially eligible for Medicare reimbursement is that the item must qualify for inclusion into an existing benefit category. There is no evidence in the clinical literature demonstrating that this design is able to function effectively as a socket for a lower limb prosthesis. Therefore, the item does not qualify for inclusion in the Artificial Limbs benefit category. The correct code to use for Medicare claims for this item is:
A9270 – NONCOVERED ITEM OR SERVICE
This coding determination is all-inclusive. Separate billing for options, accessories, additions, etc. used with this product will be denied as unbundling.
Refer to the Lower Limb Prosthesis Local Coverage Determination and related Policy Article for additional information on coverage, coding and documentation for artificial limbs.
For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.
|05/22/2015||Published on PDAC website|