True or False: Insurance companies, including Medicare will only pay for one brace every five years?
Medicare regulations state that the reasonable useful lifetime (RUL) for an AFO is five years. But there are circumstances when it’s justified to replace a Richie Brace before that time. Of course, proper documentation in the medical record is essential. Reasons to replace a Richie Brace include:
- A substantial change in the patient’s condition. There must be a citation in the narrative section of the billing document. If the patient’s condition has changed or deteriorated, it’s important to include that information. The patient may be complaining of increased pain, constrained mobility, and function that is not improving with the current AFO.
Another example is a patient who wears a leather, ankle gauntlet for treatment of posterior tibial tendon dysfunction (PTTD) and experiences significant worsening including weakness, pain, and deformity. A Richie Brace with a Medial Arch Suspender is a more appropriate treatment option.
Medicare will request documentation to show medical necessity for the new brace.
- Irreparable damage or loss. This includes things like fire, flood, loss of the device, theft, or an accident. IIf any component of the brace becomes broken, it can be considered an accident. When you are replacing the same type of AFO, use the modifier RA. Medicare requires a narrative explaining the reason for a replacement if it is before the end of the reasonable useful lifetime.
Normal wear and tear are not considered a reason to replace the brace. The brace must be repaired. If another brace is ordered, the supplier is responsible for the cost.
Understanding the Richie Brace Medicare Rules and Regulations can be Confusing.
Need more detailed information? The Richie Brace website provides in-depth detail on Richie Brace Medicare regulations and how to handle claims replacement of Richie Braces. As always, we recommend you check with Medicare to be sure you comply with all current and applicable regulations.
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