MEDICARE

Part A Intermediary
Part B Carrier

May 9, 2008

Ed Wilbourne, Sales Manager
Medi USA
6481 Franz Warner Parkway
Whitsett, NC 27377-3000

Re: M.4 OA (Models 89121, 89021, 89122, 89022, 89123, 89124, 89024, 89125, 89025, 89126, 89026, 89321, 89221, 89322, 89222, 89323, 89223, 89324, 89224, 89325, 89225, 89326, 89226)

Dear Mr. Wilbourne:

This letter is in response to your recent inquiry for coding verification of the above listed product(s) manufactured and/or distributed by Medi USA. The Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) has reviewed the documentation and information submitted for HCPCS Coding. The SADMERC conducts reviews of products to determine the correct HCPCS code(s) of DMEPOS product(s) for Medicare billing.

It is our determination that the Medicare HCPCS code(s) to bill the four Durable Medical Equipment Regional Carriers (DMERCs) is/are:

L1845 Knee orthosis, double upright, thigh and calf, with adjustable fexion and extension joint (unicentric or polycentric), medial-laterl and rotation control, with or without varus/valgus adjustment, prefabricated, includes fitting and adjustment.

This HCPCS coding decision applies to the submitted product(s) as presented to and reviewed by the SADMERC. Any modifications to the product(s) could change the HCPCS code and would need to be reviewed for coding verification. The assignment of a HCPCS code to the product(s) should in no way be contsrued as an approval or endorsement of the product(s) by SADMERC or Medicare, nor does it imply or guarantee claim reimbursement or coverage. For questions regarding claim coverage or reimbursement please contact your regional DMERC.

Should you disagree with this coding decision, a re-review of the product(s) can be initiated. The SADMERC will provide a re-review if the request is made within 45 days of the date of this letter and additional documentation is provided supporting the request. If a request for a re-review is made after 45 days, the request is treated as a new Coding Verification Review and a complete application must be submitted along with the additional documentation supporting the request.

Should you have any questions regarding this decision, please contact me at the address below or by telephone at (803) 763-8707.

Sincerely,

Janice Neely, RN
HCPCS Medical Analyst
SADMERC