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Issue Number - Name
0107-Custom Fabricated Knee Orthoses:Medical Necessity
Review Type
Complex
Claim Type
DME by Supplier, DME by Physician
Region and State
RAC 5
All States
Date Approved
09/11/2018

Description

Claims for Custom Fabricated Knee Orthoses that do not meet indications of coverage and/or medical necessity outlined in the references listed above will be denied.

Affected Code(s)

L1844, L1846

Applicable Policy References

Social Security Act, Section 1833 (e); Section 1834 (a) 
42 Code of Federal Regulations (CFR) Section 405.980 (b) and (c)
42 CFR 405.986
42 CFR 424.57
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Sections 4.26 and 4.26.1                                                                 CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Sections 5.2, 5.7, and 5.8     
Nationwide LCD L33318, Effective Date 10/01/2015; Revision Effective Date 10/16/2017
Nationwide A52465, Effective Date 10/01/2015, Revision Effective Date 01/01/2017
CMS Policy Article-A55426, Effective Date 01/01/2017, Revised 12/21/2017