Reimbursement

Medical necessity letter

Case Study & Peer reviewed clinical study

États-Unis

  • Overlay TT
    • HCPCS CODE : L5657 “Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials.”
    • MSRP 899$ USD
    • MSRP Document : Click here
  • Overlay TF
    • HCPCS CODE : L5657 “Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials.”
    • MSRP 999$ USD
    • MSRP Document download : Click here
  • Reimbursement Guide

Canada

  • Québec

    Overlay TT: RAMQ - 1146562 - Silicone gel flexible double socket, with attachment and pneumatic cushion

    RAMQ - 1145630 - Silicone gel flexible double socket

    RAMQ - Special Request War Amp - Daily living aids for adult and CHAMP Adult Program members

    Overlay TF: RAMQ - Special Request War Amp - Daily living aids for adult and CHAMP Adult Program members

  • Ontario

    Ontario: Overlay TT: ADP - CLL2DTT31 - Air Cushion Socket
    War Amp - Daily living aids for adult and CHAMP Adult Program members

  • British Columbia

    BC:
    Overlay TT & TF

    PharmaCare
    PharmaCare policies have been updated to include the Overlay TT and TF.
    The reimbursement amount is calculated as list price + Girling Formula.

    These products now fall under the following Product Identification Number (PIN): 77123530
    (Use this PIN if pre-approval is required.)

    For your convenience, here are the official documents: 
    •PharmaCare Newsletter – Province of British Columbia 
    •Prosthetic and Orthotic Policy Manual (Section 6.1.4) – Province of British Columbia


    War Amps - Daily living aids for adult and CHAMP Adult Program members

  • Alberta

    Alberta:

    Overlay TT & TF
    AADL - P141 - Air Cushion Transfemoral
    War Amp - Daily living aids for adult and CHAMP Adult Program members