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Claim the appropriate reimbursement amount using the relevant prosthetic or orthotic Product Identification Number (PIN). Prosthetic componentry may be claimed in addition to prosthetic socket PINs. In general, labour and small components (e.g., shop materials) are accounted for in the socket or procedure PINs and should not be claimed. Some components and procedures are listed below without a PIN; these may be claimed in addition to the appropriate PIN (and components for prostheses).
| Procedure | PIN | Maximum reimbursement |
|---|---|---|
| Hourly rate for repairs and adjustments (can be calculated at amounts less than a full hour) | - | $163 |
| Cosmesis, endoskeletal finish—transtibial (TT) The cosmesis can be billed under a definitive socket PIN if included in a pre-approval for a full prosthesis; if being billed separately, use this PIN |
77123532 | $600 |
| Cosmesis, endoskeletal finish—transfemoral (TF) The cosmesis can be billed under a definitive socket PIN if included in a pre-approval for a full prosthesis; if being billed separately, use this PIN |
77123532 | $1380 (full cosmesis) $600 (lower portion only - NEW) |
|
Immediate post-operative prosthesis (IPOP) |
- | $1,820 |
| Liner, fit and trim (pair). Only when replacing liners, without replacing the definitive socket | - | $82 |
| Liner—pelite | - | $440 |
| Liner—pelite and leather | - | $550 |
| Liner—pelite, leather and PPT | - | $665 |
| Liner—transfemoral (TF), thermolyn with valve | - | $720 |
| Loaner—foot | - | $165 |
| Loaner—knee | - | $220 |
| Orthotic repairs/adjustments—use if pre-approval is not required | 77123504 | reimbursement is based on actual costs but cannot exceed $399.99 |
| Orthotic repairs/adjustments—use if pre-approval is required | 77123528 |
by approval |
| Prosthetic glove, install | - | $82 |
| Prosthetic repairs/adjustments—use if pre-aproval is not required | 77123244 | reimbursement is based on actual costs but cannot exceed $399.99 |
| Prosthetic repairs/adjustments—use if pre-aproval is required | 77123529 | by approval |
| Prosthetic supplies—use if pre-aproval is not required | 77123232 | reimbursement is based on actual costs but cannot exceed $399.99 |
| Prosthetic supplies—use if pre-aproval is required | 77123530 | by approval |
| Shuttle lock procedure (during fabrication of definitive socket) | - | $300 |
| Strap, patellar tendon bearing (PTB) | - | $200 |
| Suction procedure (TF—skin fit only) | - | $360 |
| Test socket—diagnostic, dynamic, transfemoral (TF) | - | $825 |
| Test socket—diagnostic, dynamic, transtibial (TT) | - | $700 |
| Test socket—diagnostic, static, transfemoral (TF) | - | $600 |
| Test socket—diagnostic, static, transtibial (TT) | - | $500 |
| Test socket—diagnostic, static, transtibial (TR) | - | $500 |
| Test socket—diagnostic, static, transtibial (TH) | - | $500 |
Note: The maximum reimbursement amounts above often include the cost of certain small components. The cost of shop supplies is NOT eligible for reimbursement.