Reimbursement

Medical necessity letter

USA

  • Overlay TT
    • Manufacturer recommended Lcode L5646 : Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket.
    • Manufacturer recommended Lcode L5999 : Lower extremity prosthesis, not otherwise specified.
  • Overlay TF
    • Manufacturer recommended Lcode L5648 : Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket.
    • Manufacturer recommended Lcode L5999 : Lower extremity prosthesis, not otherwise specified.

Canada

  • Québec

    Québec : Overlay TT:RAMQ - 1146562 - Silicone gel flexible double socket, with attachment and pneumatic cushionRAMQ - 1145630 - Silicone gel flexible double socket RAMQ - Special Request War Amp - Daily living aids for adult and CHAMP Adult Program membersOverlay 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
    MSP - 77123232 - Prosthetic supplies – use only if NO pre-approval is required
    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