About this policy
CMS National Coverage Determination | ncd_id=207 | manual_section=280.12 | coverage_level_code=1 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
Based on professional advice, it has been determined that the sykes hernia control (a spring-type, U-shaped, strapless truss) is not functionally more beneficial than a conventional truss. Make program reimbursement for this device only when an ordinary truss would be covered. (Like all trusses, it is only of benefit when dealing with a reducible hernia). Thus, when a charge for this item is substantially in excess of that which would be reasonable for a conventional truss used for the same condition, base reimbursement on the reasonable charges for the conventional truss.
Documentation requirements
Cross Reference: Also see the Medicare Benefit Policy Manual , Chapter 15 §130. Benefit Categories: 38 - Leg, Arm, Back, and Neck Braces (orthotics)
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Backwork has no codes on record for this policy. Check the source.