Ankle-foot orthoses (AFO) and knee-ankle foot orthoses (KAFO) are covered under the Medicare Braces Benefit. For coverage under this benefit, the orthosis must be a rigid or semi-rigid device, which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of…
October is National Breast Cancer Awareness Month. During this national health observance, CMS reminds health professionals that breast cancer is the second most common form of cancer in women. Medicare provides coverage for screening mammography to facilitate the early detection of breast cancer for women with no signs or symptoms of disease. Medicare does not…
Bisphosphonate therapy:The following bisphosphonate injections (administered IV) are considered medically reasonable and necessary when administered as outlined below. The coverage of IV bisphosphonates must be supported in the medical record. The documentation should include the following information:• Criteria for the diagnosis of osteoporosis, and• History of treatment as related to progression of disease and ongoing…
A second opinion is when a doctor other than the patient’s regular doctor gives his or her view about patient’s health problem and how it should be treated. Getting a second opinion can help patients make a more informed decision about their care. Medicare Part B (Medical Insurance) helps pay for a second opinion before…
What is fluoride varnish? Fluoride varnish is a protective medication that is painted on teeth to help prevent new cavities and help stop cavities that have already started. Is fluoride varnish safe? Yes! Fluoride varnish can be used on babies from the time that they have their first tooth (around 6 months of age), and is supported…
The revised Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories), physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. The revised ABN replaces the ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007). See the revised ABN manual instructions below for detailed…
Coal workers’ pneumoconiosis (CWP), colloquially referred to as black lung disease that results from breathing in dust from coal, graphite, or man-made carbon over a long period of time. Coal worker’s pneumoconiosis occurs in two forms: simple and complicated (Progressive Massive Fibrosis (PMF)). The symptoms are Chronic cough and Shortness of Breath The Department of Labor’s Black Lung…
The Centers for Medicare & Medicaid Services (CMS) finds that the evidence is adequate to conclude that the use of autologous cellular immunotherapy treatment – Sipuleucel-T; PROVENGE® improves health outcomes for Medicare beneficiaries with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone refractory) prostate cancer. It is therefore reasonable and necessary to use for this on-label…
