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Tag: Lower limb prostheses


In brief: Fraud bill, LCD for prostheses, diamond anniversary

January 26, 2024HME News Staff

WASHINGTON – Sens. Mike Braun, R-Ind., and Bill Cassidy, R-La., have introduced legislation to target irregular billing for certain DME and other diagnostic products in the Medicare program.  The “Medicare Transaction Fraud Prevention Act” directs CMS to create a two-year pilot to oversee Medicare-covered purchasing of DME and other diagnostic testing related products for the 5% of beneficiaries that already receive electronic notices.  The bill, which would ask...

Inogen, Local Coverage Determination (LCD), Lower limb prostheses, Medicare fraud, Miller's, Paragon Healthcare

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Specialty Providers

CMS proposes changes to coverages for lower limb prostheses

January 24, 2024HME News Staff

WASHINGTON – CMS and the DME MACs have published proposed changes to the local coverage determination (LCD) for lower limb prostheses, in a “major leap forward in the care of K2 patients,” according to the American Orthotic & Prosthetic Association (AOPA).   Under the proposed changes, the agency will now allow limited coverage of microprocessor-controlled knees for select patients who are classified as K2, instead of limiting the technology to patients classified as...

American Orthotic & Prosthetic Assoc (AOPA), Lower limb prostheses

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Specialty Providers

CMS announces guidelines for prostheses

March 13, 2020Theresa Flaherty, Managing Editor

WASHINGTON - CMS has issued guidance for its new prior auth program for lower limb prostheses and sought to reassure providers that it would closely monitor implementation. CMS officials during a Special Open Door Forum March 11 also sought to reassure participants that, for the most part, it will be business as usual. “The policy hasn't changed and the way the DME MACs will review these claims will be exactly the way we've done so over the last few years,” said one official. Among...

Lower limb prostheses, Prior Authorization

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Also Noted

Researchers, former senator join fight

September 1, 2015HME News Staff

WASHINGTON - Nine leading U.S. researchers and a former U.S. senator have put pen to paper in the fight against proposed changes to coverage for lower limb prostheses. The work of the researchers was used by Medicare to back up its decision to make the changes. “We would like to go on record as stating that the works referenced do not support any of the changes outlined in the proposal,” they wrote in a letter to the U.S. Health and Human Services Department. “We are extremely...

Coverage, Lower limb prostheses

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