CMS Will Not Finalize the Draft Lower Limb Prostheses Local Coverage Determination DL33787

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Work Comp on November 4, 2015 | Posted by Erin O'Neill, PA-C, JD

On November 2, 2015, the Centers for Medicare and Medicaid Services (CMS) announced that the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will not finalize the draft Lower Limb Prostheses Local Coverage Determination (LCD) DL 33787 at this time. This decision comes after a severe backlash from numerous stakeholder organizations regarding the proposed LCD.

In July 2015, the four DME MACs released a 40 page revised LCD and Policy Article regarding Medicare reimbursement for lower extremity prostheses. The revised proposal contained extensive revisions affecting coverage, coding and payment of lower limb prostheses. Stakeholder groups, including AOPA, O&P Alliance, responded with a call for all interested parties to provide public comments to the proposal, citing the restrictive and harmful nature of the policy.

Following a review of the public comments provided in response to the draft, CMS has indicated that in 2016, they will convene a multidisciplinary Lower Limb Prostheses Interagency Workgroup. The Workgroup, comprised of researchers, policy specialists, clinicians and patient advocates from various federal agencies, will be tasked with developing a consensus statement to inform Medicare policy and make recommendations regarding the design of studies and outcome measures.

An opportunity for public comment will again be provided following release of the Workgroup’s consensus statement.

The announcement is available through the following link: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/Downloads/LLP_IAWG_Announcement.pdf