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Reimbursement Toolkits

The product/device “Supplier” (defined as an O&P practitioner, O&P patient care facility, or DME Supplier) assumes full responsibility for accurate billing of Ottobock products. It is the Supplier’s responsibility to determine medical necessity; ensure coverage criteria is met; and submit appropriate HCPCS codes, modifiers, and charges for services/products delivered. It is also recommended that Supplier’s contact insurance payer(s) for coding and coverage guidance prior to submitting claims. Ottobock Coding Suggestions and Reimbursement Guides are based on reasonable judgment and are not recommended to replace the Supplier’s judgment. These recommendations may be subject to revision based on additional information or alpha-numeric system changes. 

Navigate to reimbursement for:

Lower Limb Prosthetics | Upper Limb Prosthetics | Advanced Orthotics | Mobility and Seating

Lower Limb Prosthetics Reimbursement

C-Leg Microprocessor-Controlled Prosthetic Knee

Reimbursement Tool Kit: Private Payer Reimbursement Reference Guide, MPK Coding Options, Private Payer Billing Tips
Documentation Guides: LL Prosthetic Documentation Guide, LL Documentation Fax Request, Physician Documentation BrochureC-Leg Appeal Guide, Audit Survival Kit, LL Prosthetic Activity Chart, Documenting Functional Levels, Documenting a Replacement
Clinical Studies:  C-Leg/Compact Clinical StudiesBilateral Studies and Articles

Compact Microprocessor-Controlled Prosthetic Knee

Reimbursement Tool Kit: Compact Reimbursement Reference Guide, MPK Coding Options
Documentation Guides: Prosthetic Documentation Guide, Documentation Fax Request, Physician Documentation Brochure, C-Leg Appeal Guide, Audit Survival Kit, LL Prosthetic Activity Chart, Documenting Functional Levels, Documenting a Replacement
Clinical Studies: C-Leg/Compact Clinical Studies, K2 Clinical Studies

Kenevo Microprocessor-Controlled Prosthetic Knee

Reimbursement Tool Kit: Kenevo Reimbursement Reference Guide, Billing Tips, MPK Coding Options
Documentation Guides: Prosthetic Documentation Guide, Documentation Fax Request, Physician Documentation Brochure, Audit Survival Kit, LL Prosthetic Activity Chart, Documenting Functional Levels, Documenting a Replacement
Clinical Studies: K2 Clinical Studies

Genium Microprocessor-Controlled Prosthetic Knee

Reimbursement Tool Kit: Reimbursement Reference Guide, Coding and Billing, MPK Coding Options, Genium-X3 Evidence
Reimbursement Tool Kit – Canada: : Reimbursement Reference Guide, Genium-X3 Evidence
Documentation Guides: LL Prosthetic Activity Chart, Documenting Functional Levels, Documenting a Replacement
Clinical Studies: Genium/X3 Clinical Studies

X3 Microprocessor-Controlled Prosthetic Knee

Reimbursement Tool Kit: Reimbursement Reference Guide, Coding and Billing, MPK Coding Options
Documentation Guides: LL Prosthetic Activity Chart, Documenting Functional Levels, Documenting a Replacement
Clinical Studies: Genium/X3 Clinical Studies

Harmony

Reimbursement Tool Kit: Reimbursement Reference Guide
Documentation Guides: LL Prosthetic Documentation Guide, LL Documentation Fax Request, Physician Documentation BrochureHarmony Appeal Guide, Audit Survival Kit, Documenting Functional Levels, Documenting a Replacement
Clinical Studies:  Vacuum Studies Bibliography

Helix 3D Hip

Reimbursement Tool Kit: Helix Coding Justification, MPK Coding Options
Documentation Guides: LL Prosthetic Documentation Guide, LL Documentation Fax Request, Physician Documentation Brochure, Audit Survival Kit
PDAC Verification: Helix 3D Hip
Clinical Studies: Prosthetic Hip Clinical Studies

7E9 Hip Joint

Reimbursement Tool Kit: 7E9 Coding and Billing Tips, 7E9 Coding Options
Documentation Guides: LL Prosthetic Documentation Guide, LL Documentation Fax Request, Physician Documentation Brochure, Documenting Functional Levels, Documenting a Replacement
Clinical Studies: Prosthetic Hip Clinical Studies

Triton smart ankle

Reimbursement Tool Kit: Reimbursement Reference Guide, MPK Coding Options
Documentation Guides: LL Prosthetic Documentation Guide, LL Documentation Fax Request, Physician Documentation Brochure, Documenting Functional Levels, Documenting a Replacement
Clinical Studies: Microprocessor Ankle/Foot Clinical Studies

Meridium

Reimbursement Tool Kit: Reimbursement Reference Guide, Meridium Coding and Billing Tips, MPK Coding Options
Documentation Guides: LL Prosthetic Documentation Guide, LL Documentation Fax Request, Physician Documentation Brochure, Documenting Functional Levels, Documenting a Replacement
Clinical Studies: Microprocessor Ankle/Foot Clinical Studies
 

Upper Limb Prosthetics Reimbursement

Above Elbow (AxonBus Prosthetic System (APS) – Michelangelo, AxonArm Ergo, AxonHook, AxonRotation)

Reimbursement Tool Kit: AE-APS Reimbursement Reference Guide, AE-APS Billing Tips, AE-APS Coding Options
Documentation Guides: UL Prosthetic Documentation Guide, UL Documentation Checklist, UL Documentation Fax Request, Physician Documentation Brochure, Audit Survival Kit

Below Elbow (AxonBus Prosthetic System (APS) – Michelangelo, AxonHook, Axon Rotation)

Reimbursement Tool Kit: BE-APS Reimbursement Reference Guide, BE-APS Billing Tips, BE-APS Coding Options
Documentation Guides:  UL Prosthetic Documentation Guide, UL Documentation Checklist, UL Documentation Fax Request, Physician Documentation Brochure, Audit Survival Kit

Dynamic Arm and Dynamic Arm +

Reimbursement Tool Kit: Above Elbow Myobock Coding Options, Above Elbow Basic System Options
Documentation Guides:  UL Prosthetic Documentation Guide, UL Documentation Checklist, UL Documentation Fax Request, Physician Documentation Brochure, Audit Survival Kit

Myobock,  Above Elbow / Below Elbow

Reimbursement Tool Kit: Above Elbow Myobock Coding Options, Below Elbow Myobock Coding Options, Above Elbow Basic System Options, Below Elbow Basic System Options
Documentation Guides: UL Prosthetic Documentation Guide, UL Documentation Checklist, UL Documentation Fax Request, Physician Documentation Brochure, Audit Survival Kit

Pediatric UL Prosthetics

Tool Kit: Pediatric Coding Options (passive, body powered, and myoelectric)
 

NEO Orthotics Reimbursement

Agilium Freestep

Reimbursement Tool Kit: Reimbursement Reference Guide, Billing Tips for Private Pay, Documentation Request for Private Pay

Carbon Ankle Seven

Reimbursement Tool Kit: CA7 Coding Options, CA7 Billing Tips, CA7 Justification
Documentation Guides: AFO-KAFO Documentation Guide, Documentation Fax Request

C-Brace

Reimbursement Tool Kit: Reimbursement Starter Packet, Reimbursement Reference Guide, Coding-Billing Tips, C-Brace Justification_(Orthotist), C-Brace Justification (Physician)

E-MAG Active

Reimbursement Tool Kit: Email reimbursement911@ottobock.com for coding and billing tips.
Documentation Guides: AFO-KAFO Documentation Guide, Documentation Fax Request
PDAC Verification: E-Mag Active PDAC
Clinical Studies: Stance Control Clinical Studies

FreeWalk Stance Control

Documentation Guides: AFO-KAFO Documentation Guide, Documentation Fax Request
PDAC Verification: FreeWalk PDAC Verification
Clinical Studies: Stance Control Clinical Studies

RGO Hip Joint

Reimbursement Tool Kit: RGO Coding and Billing Tips, RGO Justification
Documentation Guides: AFO-KAFO Documentation Guide, Documentation Fax Request
PDAC Verification: RGO PDAC Verification
 

Adult & Pediatric Mobility and Seating Reimbursement

Manual Wheelchairs and Pediatric Strollers

PDAC Verifications: Manual Wheelchairs and Pediatric Strollers (ZIP)

Custom Seating (OBSS and Nutec)

Reimbursement Tool Kit: Custom Seating Reimbursement Reference Guide, Coding and Billing Tips
Documentation Guides: Custom Seating Medicare Criteria for Coverage