GE module DS200TCCAG1BAA original stock
Technical data of product parameters
The application supports a preliminary benefit category determination that the Rotation
Adapter 4R57 is used in addition to a lower extremity prosthesis and would fall under the DS200TCCAG1BAA
Medicare benefit for artificial legsIn accordance with regulations at 42 CFR § 414.236, fee schedule amounts for new HCPCS
codes for items and services that have a fee schedule pricing history, the previous fee
schedule amounts for the old code(s) are mapped to the new code(s) to ensure continuity of
pricing. Mapping fee schedule amounts can occur based on different kinds of coding changes.
This includes when there is a single code that describes two or more distinct complete items DS200TCCAG1BAA
(for example, two different but related or similar items), and separate codes are subsequently established for each item, the fee schedule amounts that applied to the single code continue to
apply to each of the items described by the new codes. In this case, the Ottobock Rotation
Adapter 4R57 has a fee schedule pricing history of being previously classified and paid under
HCPCS code L5984. Based on continuity of pricing, the preliminary payment determination
for code K1022, for this particular positional rotation adapter, is that this item should be DS200TCCAG1BAA
priced using the existing fee schedule amounts described by HCPCS code L5984.
Ottobock, the manufacturer of the Rotation Adapter 4R57, agreed with the preliminary
benefit category and payment determinations. Proteor USA, a different manufacturer, felt the
fee schedule amounts should be higher, indicating that the rotation adaptor described by code
K1022 is more complicated to develop than other rotation adaptors under code L5984. The fee schedule amounts for HCPCS code L5984 will be crosswalked to HCPCS code
K1022, resulting in an average 2022 fee schedule amount of $676.08. In response to the DS200TCCAG1BAA
comments from Proteor USA, this item has a history of pricing under code L5984; and
therefore, the fee schedule amounts used to pay for the item under code L5984 must be
mapped to the new code K1022 in accordance with the continuity of pricing rules at 42 CFR
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