09/25/2017
Reasonable Useful Lifetime and Duplicate Items - Medicare
Medicare denied CPT L4361 (Pump Cam-walker) & L4386, according to the 5 year rule, which doesn't a make sense. Please advise if this is correct.
The walking boot was denied correctly by Medicare, if the patient received the item within the past five years from a Medicare DME supplier. AFOs and walking boots are not on the list of items, where it would be necessary to replace on a more frequent basis, unless there are extenuating circumstances such as theft, loss, irreparable wear, etc. If the replacement does fall into one of those circumstances, a redetermination will need to be sent to justify the necessity.
Below are two articles from the Noridian website for your reference:
- https://med.noridianmedicare.com/web/jddme/article-detail/-/view/2230703/reasonable-useful-lifetime-and-duplicate-items-billing-reminder
- https://med.noridianmedicare.com/web/jddme/article-detail/-/view/2230703/reasonable-useful-lifetime-clarification