Cahaba Coverage Policy on IRF Admission after Single Joint Replacement Surgery
Medicare contractor Cahaba GBA issued a Draft Local Coverage Determination (LCD) for Surgery: IRF Admission after Single Joint Replacement with CMGs A0801-A0806 (DL32816). The LCD would affect Alabama, Georgia and Tennessee. AOTA submitted comments on September 10, 2012. We argued that Cahaba should not deny coverage of IRF care based on diagnosis alone, the coverage policy should take into account the professional judgment of rehabilitation physicians and the interdisciplinary team, and the draft LCD constitutes a “rule of thumb” prohibited by Medicare. Stay tuned for future updates on the status of this LCD.
On September 13, 2012, Cahaba announced that the draft LCD for Surgery: IRF Admission after Single Joint Replacement with CMGs A0801-A0806 (DL32816) has been rescinded and will not be finalized.
