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CMS added nine items to the Required Prior Authorization List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies, a list of items that require prior authorization as a condition of payment. One of these items is L1951 - Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment.
Providers must ensure that any item coded as L1951 meets all the requirements of code utilization outlined in the DME MAC
Read the ankle-foot/knee-ankle-foot orthosis LCD and policy article.
Additionally, PDAC coding verification is not currently required for L1951, but the DME MACs are issuing a Coding Verification Requirement for L1951 effective for claims with dates of service on or after December 1, 2024. This means submitting L1951 on or after December 1, 2024, will require that the item dispensed has PDAC coding verification for L1951 and publication of such on the PDAC Product Classification List.
Reference:
https://www.cgsmedicare.com/jc/pubs/news/2024/05/cope156603.html
Guidance regarding CMS prior authorization for DMEPOS may be found here: https://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/dmepos/downloads/dmepos-pa-frequently-asked-questions-06-01-2018.pdf.