Does L3250 require prior authorization?

No, L3250 does not require prior authorization (high confidence). Covered without prior authorization.

Backwork Sign up free

`L3250`, Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe,

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; for DMEPOS items that require a WOPD, the supplier must have received a signed SWO/WOPD before delivery.
For DMEPOS base items that require a WOPD and also have separately billed options/accessories/supplies, the WOPD must list the base item and may list the separately billed associated items prior to delivery.
Suppliers are required to maintain proof of delivery documentation and make POD available to the Medicare contractor upon request.

Suppliers must follow the LCD-related Standard Documentation Requirements Article, the LCD-related Policy Article, the Supplier Manual, and DME MAC publications for additional documentation and payment rules.

ICD-10 diagnosis codes required for coverage of prosthetic shoes are specified in the LCD-related Policy Article and must be documented per that related article.

No specific documentation requirements are provided in this excerpt.

Key Coverage Criteria

An item is covered only if it is an eligible Medicare benefit category, is reasonable and necessary for diagnosis or treatment or to improve functioning of a malformed body member, and meets all Medicare statutory and regulatory requirements.
Prosthetic shoes (HCPCS L3250) are covered when they are an integral part of a prosthesis for a beneficiary with a partial foot amputation.
An item that is correctly coded in accordance with CMS HCPCS guidelines, applicable LCDs, LCD-related Policy Articles, and DME MAC articles meets a necessary coding requirement for coverage.
No explicit covered indications/diagnoses/clinical scenarios are provided in the supplied document excerpt.
Replacement of a missing body part (prosthesis), including arms, breasts, ears, feet, hands, legs and maxillofacial (jaw and face).
Lower limb prostheses designed to replace portions of the lower extremity to improve function.

5 Active Policies

HUMANA-PROSTHETICS-OK-MEDICAID, Prosthetics

HUMANA-PROSTHETICS-KY-MEDICAID, Prosthetics

HUMANA-PROSTHETICS-SC-MEDICAID, Prosthetics

ANTHEM-CG-DME-20, Orthopedic Footwear

L33641, Orthopedic Footwear

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about L3250 Sign up free

L3250, Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe,