Recently, AOPA asked the DME MACs to clarify this existing language in the AFO/KAFO Policy Article related to custom fabricated braces: 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.
On September 3, AOPA reported and confirmed that there has been no change to the documentation requirements for custom fabricated AFOs/KAFOs and the above passage is in reference to miscellaneous or unlisted codes. The DME MACs also stated they will clarify this in a future Policy Article revision.
The DME MACs just released the following revised AFO/KAFO Policy Article, and as promised they clarified the custom fabrication language: If the item is custom fabricated and does not have a specific HCPCS code, 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) should be entered in the narrative field of an electronic claim or on Item 19 of a paper claim. (Refer to the LCD-related Standard Documentation Requirements article (A55426) for more information regarding billing of items with HCPCS codes that include miscellaneous, NOC, unlisted, or non-specified in their narrative descriptions.)
The revised AFO/KAFO Policy Article will be effective October 1, 2020. A copy of the revised article can be found here.
Questions? Contact Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org