Podiatrists can improve patients’ lives and help reduce the overall cost of healthcare by implementing a comprehensive fall prevention program. SafeStep offers ample opportunity and encourages podiatrists to learn more about how to start one and to not be frightened by alerts and postings that imply an assumption of great risk by utilizing custom AFOs as a part of treatment.
“Comparative Billing Reports” from Medicare demonstrate that on average, DPMs dispense 0.7 L1940 devices, per podiatrist, PER YEAR! There is not a problem of custom AFO over utilization but most definitely one of underutilization.
Medicare policy is clear that patients documented to have orthopedic risk factors for falls are covered for custom AFO’s including the Moore Balance Brace. Recent posts intended to discourage AFO utilization serve as reminders of the importance of following established treatment protocols and of Medicare documentation requirements.
The Medicare LCD states that to be covered, an item must “be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member”.
The Medicare Benefit Policy Manual states that appliances are covered when “used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body.”
If biomechanical examination determines any of the following diagnoses to be present, clinical indications demonstrating medical necessity are met and that if dispensing custom AFO’s, podiatrists can be confident of satisfying Medicare guidelines:
Muscle weakness (728.87)
Ataxia, muscular incoordination (781.3)
Gait abnormality/ staggering, ataxic (781.2)
Osteoarthritis, localized primary ankle & foot (715.17)
Arthropathy, unspecified, ankle and foot (716.97)
Pain in joint, ankle, foot (719.47)
Instability of joint, ankle & foot (718.87)
Dropfoot (736.79)
Hemiplegia (438.20)
SafeStep will continue to be a strong supporter of podiatrists’ role in fall prevention and embraces the opportunity to dispense custom AFO’s as a legitimate means of treatment.