We are thrilled to announce that on July 18, 2024, the Centers for Medicare and Medicaid Services (“CMS”) and the Durable Medical Equipment Medicare Administrative Contractor (“DME MAC”) Medical Directors released the much-anticipated final Local Coverage Determination (“LCD”) L33787 Lower Limb Prostheses.
They also published an updated Local Coverage Article (“LCA”) that offers additional details on this new coverage policy and posted a response to the comments they received from O&P stakeholders on their respective websites.
The final LCD expands the coverage criteria for microprocessor-controlled prosthetic knees (“MPKs”)—including fluid and pneumatic knees—for Medicare Functional Classification Level (“MFCL”) 2 beneficiaries, individuals with lower limb loss who are considered limited community ambulators and require a prosthetic knee based on the best available evidence. The effective date for this final LCD is September 1, 2024.
In light of the news above, a new wave of decisions is positively impacting patients and the practitioners who serve them.
This webinar will:
Detail new Medicare coverage policies of advanced O&P care
Answer coding, coverage, and payment questions
Describe additional efforts necessary to effectuate access to care, and
Illustrate the impact on payers other than Medicare so all patients benefit.
New Coverage, Coding, and Payment policies to be discussed include:
Micro-processor Knee Expansion to K-2 Beneficiaries with Limb Loss
Clarification that Powered Orthoses Can be Covered as Orthoses under Medicare, expanding orthotic coverage
New HCPCS Code for Bone-Anchored Prostheses (Osseointegration)
Upper Extremity Prosthetic Code Clarifications to Expand Access
Links to supporting documents:
PDF of the Slides used in the webinar