Medicare recently changed their coverage determination process for orthotics and prosthetics. They now require additional physician documentation to provide coverage.
- "The treating physician's record, not the prosthetist's are used to justify payment"
- "The records must document the patient's current functional capabilities and his/her expected functional potential, including an explanation for the difference"
Medicare also requires that the prescribing physician's records collaborate the prosthetist's findings and recommendations, and without this information will deny coverage even after the orthosis or prosthesis was provided.
To assist you, we have included below a downloadable outline of the information that Medicare requires. Please incorporate this information into your report and send us a copy, so we can begin treatment.