Medicare Reverses The Height Requirement For AFO Devices

Thankfully, clear minds have prevailed. Medicare has rescinded its recent policy that would have required ankle foot orthotic (AFO) devices to reach the head of the fibula.

Practitioners can still prescribe prefabricated and custom AFOs that extend above the ankle joint without a height requirement. The new bulletin from Medicare reads as follows:

“DME MAC Jurisdiction C News
Ankle-Foot Orthoses/Knee-Ankle-Foot Orthoses LCD related Policy Article - Revised – The related Policy Article for the Ankle-Foot Orthosis/Knee-Ankle-Foot Orthosis is being revised. The Policy Article with an effective date of January 1, 2013 included Coding Guidelines for AFOs that included a height requirement. The height requirement is being removed. The effective date for the revised Policy Article is for dates of service on or after January 1, 2013. For more information :

http://www.cgsmedicare.com/jc/pubs/news/2013/0213/cope21209.html . “

I discussed the previous Medicare policy statement in a recent blog (see http://tinyurl.com/a8wabum .)

This previous policy created much confusion in our profession. Many companies, including mine, scrambled to revise their braces to conform to the new guidelines. Now, we recognize that Medicare did not base these height requirements upon sound scientific evidence and they had little merit.

I am grateful for the efforts of the American Podiatric Medical Association (APMA), particularly the Health Policy Committee and the Durable Medical Equipment Subcommittee, which worked diligently on behalf of our profession to get the recent height requirements reversed. As a member of this subcommittee, I was impressed by the collaborative effort between the APMA and the American Orthotic and Prosthetic Association, which joined forces to provide a powerful appeal to Medicare about the recent policy statement.

For now, podiatric physicians can prescribe custom and non-custom AFO devices to their patients according to patient requirements, not Medicare requirements. Practitioners can make the best decision for patient outcome based upon clinical findings and not reimbursement restrictions. The only ankle braces that require Pricing, Data Analysis and Coding (PDAC) verification are those with code L 1906- Multiligamentous Pre-Fabricated Ankle Braces. Custom AFOs do not require PDAC approval.

How long will this last? My advice is to stay in touch with the APMA for updates and decisions, which can affect your practice on a daily basis.



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