CMS is using the lack of physician documentation to deny claims not only for lower-limb prostheses, but for orthoses as well, according to Joe McTernan, AOPA director of coding and reimbursement services. He summarizes the requirements for AFOS and KAFOs set forth in the Local Coverage Determination and Policy Article, noting that they must meet the definition of a brace under the Medicare Braces benefit category.

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