Medicare and PDAC Approval

As a follow up to our response to Medicare’s new height requirement for AFO’s, we want to remind our customers that first, our new adjustable medial upright extension does allow the practitioner to adjust the height of our AFO’s to a specific height requirement as previously posted, second, if needed, please be sure to request the new upright for your medicare patients, and lastly, the only type of AFO that requires a PDAC Coding verification letter is the L1906. Insightful does not use that code for any of its current bracing. To verify this for yourself, please see the PDAC website listing those that are required. The link to this page is below.

https://www.dmepdac.com/review/items_requiring_coding_verification_reviews.html

New Medial Upright Extension

Insightful Products responds to the new 2013 Medicare Height requirement with an adjustable medial extension that allows the practitioner the ability to remove and relocate the extension to the preferred height.

Some of our competitors have suggested additional brace add-ons that also provide additional Lcodes to solve this new height requirement. These additional Lcodes must still meet the threshold of “Medical Necessity”. For instance, a pre-tibial shell is medically needed for distribution of pressure from a floor reaction, anterior stop or solid ankle design. Free motion articulated designs, by definition, do not necessitate a pre-tibial shell. Our add-on solution does not change the well established LCode descriptors and provides some additional medial/lateral stability.

PDAC letters obtained before the rule change do not necessarily make AFOs comply with the current height requirements.