IMPORTANT MEDICARE CODING UPDATE

PROTEOR USA is writing with an important coding update for our customers who order our RUSH line of adult prosthetic feet.  In order to provide our customers with clear guidance for billing Medicare, in late 2016 PROTEOR USA submitted five of its RUSH Foot® collection products to the Medicare Pricing, Data Analysis and Coding Contractor (PDAC) for code verification.  Code verification is the process by which the PDAC approves a code for billing Medicare for a prosthetics product like the RUSH Foot®. 
 
On January 10, PROTEOR USA received Coding Verification Determination letters from the PDAC approving codes for its RUSH Foot® products.  The approved codes can be found on the PDAC’s Durable Medical Equipment Coding System, which is on the PDAC website at https://www.dmepdac.com/dmecsapp/do/search.  The code approvals took effect January 10.
 
The PDAC approved billing both the L5987 and L5984 codes for the soon to be released next generation RUSH® foot, the RUSH® Rogue.  
 
The PDAC also approved the following codes for other RUSH Foot® products:
 
  • RUSH Chopart® – L5976
  • RUSH LoPro® – L5981
  • RUSH® ROVER – L5981
  • RUSH HiPro® – L5981
 
As many of you are aware, the PDAC’s assignment of the L5981 code for the RUSH HiPro® is in conflict with the Veterans Health Administration’s practice for much of the past year, which has been to pay claims for the RUSH HiPro® billed using the L5980 code.  PROTEOR USA is requesting reconsideration of the PDAC’s decision based on the clinical and technical specifications of the RUSH HiPro®.  There is a reconsideration period of 45 days following the PDAC determination.
 
According to the PDAC website, customers should use the codes above when billing Medicare for RUSH Foot® products.  It is important to note that the PDAC’s determinations apply ONLY to Medicare.  
 
Customers should continue to bill other payers based on their coding policies.  Since its founding, PROTEOR USA has developed and tested its foot products according to the industry accepted 2010 AOPA Foot Project Standards. These recommendations can be found on LCodeSearch.com.
 
Please feel free to contact PROTEOR USA at info@rushfoot.com if you have any questions.
 
**This memorandum and information herein applies to US customers only.