Education & Training
FindACode.com
Find A Code, LLC
To: All New Hampshire and Vermont Providers --
The Benefits Improvement and Protection Act of 2000 amended 1834(h)(1) of the Social Security Act by adding a provision (1834 (h)(1)(g)(i)) that requires Medicare payment to be made for the replacement for prosthetic devices which are artificial limbs, or for the replacement of any part of such devices, without regard to continuous use or useful lifetime restrictions if an ordering physician determines that the replacement device, or replacement part of such a device, is necessary.
Payment may be made for the replacement of a prosthetic device which is an artificial limb, or replacement part of a device if the ordering physician determines that the replacement device or part is necessary because of any of the following:
A change in the physiological condition of the patient;
An irreparable change in the condition of the device, or in a part of the device; or
The condition of the device, or the part of the device, requires repairs and the cost of such repairs would be more than 60 percent of the cost of a replacement device, or, as the case may be, of the part being replaced.
This provision supersedes any rule that as of the date of enactment of this Act, may have applied to a 5-year replacement rule with regard to prosthetic devices. In addition, this provision shall apply to items replaced on or after April 1, 2001.
If you should have any questions regarding this bulletin, please contact our Customer Service Department @ (866)-539-5593.
Trans. AB-01-06. This and other transmittals can be located by clicking Medicare Transmittals and Memorandums.
The Benefits Improvement and Protection Act of 2000 amended 1834(h)(1) of the Social Security Act by adding a provision (1834 (h)(1)(g)(i)) that requires Medicare payment to be made for the replacement for prosthetic devices which are artificial limbs, or for the replacement of any part of such devices, without regard to continuous use or useful lifetime restrictions if an ordering physician determines that the replacement device, or replacement part of such a device, is necessary.
Payment may be made for the replacement of a prosthetic device which is an artificial limb, or replacement part of a device if the ordering physician determines that the replacement device or part is necessary because of any of the following:
A change in the physiological condition of the patient;
An irreparable change in the condition of the device, or in a part of the device; or
The condition of the device, or the part of the device, requires repairs and the cost of such repairs would be more than 60 percent of the cost of a replacement device, or, as the case may be, of the part being replaced.
This provision supersedes any rule that as of the date of enactment of this Act, may have applied to a 5-year replacement rule with regard to prosthetic devices. In addition, this provision shall apply to items replaced on or after April 1, 2001.
If you should have any questions regarding this bulletin, please contact our Customer Service Department @ (866)-539-5593.
Trans. AB-01-06. This and other transmittals can be located by clicking Medicare Transmittals and Memorandums.
