Wiki Please Help - DME Supply, or DME Prosthesis?

[nolanspade]

I am looking for literature on CMS regarding the code L5673 which is for:

L5673 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism​

I can't find a clear answer as to whether it is considered a supply or a prosthetic device.
If it is a supply, I would like to confirm CMS' documentation requirements.

The MAC is CGS DME Jurisdiction C.

I am a newly certified auditor, and this is escaping my expertise.

 

[rmjanowitz]

L5673 is a prosthetic locking liner and falls under Medicare's lower limb prosthetic benefit. It's not a DME supply. It goes over a patient's stump and locks into the bottom of the socket on the prosthesis to keep the prosthetic limb attached to the person. They degrade over time and need to be replaced usually once a year. Patients should have two at any point in time for hygiene purposes, one to wear and one to wash.

As far as I know, they follow the normal general documentation guidelines: SWO, Medical Record Information (including continued need/use, if applicable), Correct Coding, Proof of Delivery. Medical necessity is established with the prosthetic limb as long as Medicare paid for the limb. If the prosthetic limb is medically necessary, so are the liners as long as they're being used with a prosthetic that uses a suspension system with a locking mechanism.