L9900, Orthotic and prosthetic supply, accessory, and/or service component of another
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Physician certification is required for coverage documenting that the component is ineffective for ADLs, that a medical-condition change necessitates a different component, or that the component reached reasonable useful life.
- For repairs, include original purchase date of the item repaired, the reason for repair/replacement, identification of the item and parts repaired, functionality status, and the manufacturer invoice cost.
- When billing replacements include original purchase date, last replacement date of the item billed, and reason for replacement.
- For exceptions to battery or other limits, submit a narrative in item #19 of the electronic 5010 claim form or an attachment for paper claims.
Key Coverage Criteria
- Replacement of an existing cochlear implant external component is covered when a physician certifies the existing component is ineffective to the point of interfering with activities of daily living.
- Replacement is covered when a change in the patient's medical condition necessitates a different type of external cochlear implant component as certified by a physician.
- Replacement is covered when the existing external component has reached its reasonable useful life; the reasonable useful life of a sound processor is not less than 5 years.
- An item is covered only if it meets Medicare benefit category eligibility, is reasonable and necessary for diagnosis/treatment or to improve functioning of a malformed body member, and meets all other Medicare statutory and regulatory requirements.
- Prefabricated knee orthoses with joints or with condylar pads and joints (HCPCS L1810, L1812, L1820, L1821) are covered for ambulatory beneficiaries with knee weakness or deformity who require stabilization.
- Knee orthoses with a locking knee joint or rigid knee orthoses (HCPCS L1831, L1836) are covered for beneficiaries with knee flexion or extension contractures who demonstrate at least 10 degrees of movement on passive range of motion testing (nonfixed contracture).
3 Active Policies
A53708, Billing and Coding: External Components for Cochlear Implants
L33318, Knee Orthoses
L33737, Eye Prostheses
Related Codes
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