Earlier this year, AOPA communicated the exciting news that the DME MACs had published a proposed revision to the Medicare Lower Limb Prosthesis Policy that would expand coverage for pneumatic/hydraulic and/or microprocessor controlled prosthetic knees and certain advanced prosthetic feet for beneficiaries classified as functional level 2 (K2) ambulators. The proposed LCD represented a tremendous shift in coverage policy that recognized the clinical benefits these prosthetic components may offer to an entirely new population of patients that may benefit the most from what they offer. On Thursday, July 18, 2024, the DME MACs published the final version of the revised LCD, Policy Article, and a summary of written comments they received along with their response. The revised policy, which will be effective for dates with claims of service on or after September 1, 2024, remained relatively unchanged from previous draft. The only significant change fro the draft removed the requirement that “all” non-microprocessor controlled knees should be considered and ruled out before a microprocessor controlled knee would be covered for K2 amputees. During the February 22, 2024 public meeting that was held to discuss the proposed policy, AOPA and other commenters expressed concern that this requirement would create unnecessary burdens to care and should be revised. The DME MACs agreed with this comment and the final policy only requires that “other” knees be considered before a microprocessor knee is covered for K2 patients.
Revisions to the LCD closely mirror the proposed revisions that were published previously but the Policy Article includes several significant, but positive updates. The most relevant update is the inclusion of specific examples of activities that prosthesis users should be able to achieve at each functional level. The Policy Article specifically states that the lists are not all inclusive or mutually exclusive but they do provide valuable reference points that will help members of the rehabilitation team properly document patients’ functional capabilities.
The August 2024 Reimbursement Page will provide more details about the final LCD and Policy Article and how it may impact your patients.
Questions regarding the proposed LCD revisions may be submitted to Joe jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.