Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)

Coverage for hip and knee major joint replacement is governed by LCD L36007 and requires that services meet the LCD’s reasonable and necessary criteria. Providers must not bill Medicare for non-covered services as if covered and should use the appropriate modifier when billing non-covered services. All claims must be supported by legible medical records with patient identification, dates of service, provider signature, and documentation that justifies the selected ICD-10-CM and CPT/HCPCS codes.

"Coverage for lower extremity major joint replacement (hip and knee) is subject to the reasonable and necessary requirements of Local Coverage Determination L36007; services meeting LCD L36007 crite..."

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