Skip to Main Content
Issue Number - Name
0128-Spinal Orthoses within the Reasonable Useful Lifetime (RUL)
Review Type
Automated
Claim Type
DME by Supplier, DME by Physician
Region and State
RAC 5
All DME
Date Approved
12/11/2018

Description

Claims for more than one spinal orthosis within the reasonable useful lifetime will be denied.

Affected Codes

L0627, L0631, L0637, L0642, L0648, L0650

Applicable Policy References

Social Security Act: Section 1833(e) and Section 1834(a)
42 CFR, Section 405.980 (b) and (c)
42 CFR, Section 405.986
42 CFR, Section 414.210
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110.2.C
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Sections 4.26, 4.26.1, Chapter 5, Sections 5.2, 5.7, and 5.8