Reimbursement

Medical necessity letter

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

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 SocketWar Amp - Daily living aids for adult and CHAMP Adult Program members

  • British Columbia

    BC:
    Overlay TT & TF
    Prosthetic supplies—use if pre-aproval is required :| 77123530 | by approval
    War Amp - 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