DME MACs Clarify AFO/KAFO Policy Article Language Regarding Custom Fabricated Orthoses


The DME MACs have recently clarified language in the AFO/KAFO Policy Article that currently states the following:

MISCELLANEOUS

In addition, if the item is custom fabricated, a complete and clear description of the item, including what makes this item unique, and a breakdown of charges (material and labor used in fabrication). This information should be entered in the narrative field of an electronic claim.

Previous versions of the Policy Article contained the same language but also included contextual language that clearly indicated that the additional requirements only applied to services described by unlisted procedure codes for lower limb orthoses (L2999).

AOPA asked the DME MACs to clarify that the current language is NOT intended to apply to all custom fabricated AFO/KAFO codes and that the contextual reference to unlisted codes that was present in previous versions of the Policy Article was an inadvertent omission.

The DME MACs have confirmed that there has been no change to the documentation requirements for custom fabricated AFOs/KAFOs and that the additional information referenced in the Policy Article is only required when submitting unlisted codes.  They indicated that they will clarify this further in a future revision to the AFO/KAFO Policy Article.

Questions regarding this issue may be addressed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.