|
L5618 |
 |
Addition to lower extremity, test socket, symes
| short | Test socket symes |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
L5620 |
|
Addition to lower extremity, test socket, below knee
| short | Test socket below knee |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
L5622 |
|
Addition to lower extremity, test socket, knee disarticulation
| short | Test socket knee disarticula |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
L5624 |
|
Addition to lower extremity, test socket, above knee
| short | Test socket above knee |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
L5626 |
|
Addition to lower extremity, test socket, hip disarticulation
| short | Test socket hip disarticulat |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 4.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
L5628 |
|
Addition to lower extremity, test socket, hemipelvectomy
| short | Test socket hemipelvectomy |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|