L6704 Fills a Need

With disabled athletes making headlines for their tremendous accomplishments, more amputees are looking for ways to return to the physical routines they enjoyed prior to amputation, or to become active as they never had the chance before. Recreation therapy gives amputees an outlet to recover and regain a sense of self.

Recovery and well-being

According to the National Council for Therapeutic Recreation Therapy, recreational therapy uses recreation involvement as a means to both physical and psychological health, recovery and well-being. For upper extremity amputees, however, there previously had been an obstacle to participation – reimbursement for sports and recreational devices.

“The science of therapeutic recreation has always fallen into third place behind physical therapy and occupational therapy,” Bob Radocy, president and chief executive officer of TRS in Boulder, Colo., said.

This changed earlier this year when a new L-code, L6704, went into effect. The Centers for Medicare and Medicaid Services (CMS) issued L6704 to cover all terminal sports, recreation and work attachment devices, in any material and any size.

“Seeing the government recognize now, through L6704, that they will reimburse sports and recreational adaptations – at what seems to be a relatively fair level for certain types of patients – is a tremendous step forward. It is a progressive thing for them to do,” Radocy said.

Reasonable option

Radocy said he is pleased to see the code from a professional perspective, and that, at some point, it will begin to help with a business perspective, as many private insurance companies look to L-codes for justification of what they reimburse. Typically, other than workers’ compensation-type injuries, insurance companies have not covered sports and recreational componentry for people who have lost hands, he said.

“Hopefully this will be the start so in the future [insurance companies] will consider it as a reasonable option for people,” he said. “In my mind, as a designer and an amputee, there is never going to be the one all-purpose hand that does everything.”

He also said that the new code exemplifies that activity-specific prostheses finally are taking hold in the industry.

Why now?

Amputees involved in sports activities
Images reprinted with permission of TRS.

Radocy said that prior to the new code, there was no coding specifically related to sports and recreational devices.

“Generically, one code did exist many years ago … but it wasn’t necessarily used only for sports activities. It was a functional cosmetic hand to a certain extent,” he said.

Before the creation of this new code, practitioners typically would submit devices under the L7499 miscellaneous codes, which caused some difficulty in gaining proper reimbursement, said Randall Alley, BSc, CP, LP, FAAOP, CFT, chief executive officer of biodesigns inc.

“Now I would use L6704 to cover that [device] and – provided the individual is an appropriate candidate – I shouldn’t need to be overly concerned about obtaining reimbursement from Medicare,” Alley said.

Ron Farquharson, president of Texas Assistive Devices LLC, speculated that CMS created this new code to unclutter the current list of codes.

“CMS has been on a decade long campaign to streamline the L-code system and reduce the number of codes,” Farquharson said. “They deleted a number of other terminal device codes and replaced them with L6704.”

According to a SADMERC official contacted by O&P Business News, CMS originally charged the organization with a coding revision for a group of deleted codes, resulting in L6704.

Who benefits?

Many amputees are benefiting from the addition of the code. The hope in the O&P profession is that athletes will have access to better devices and amputees will have more activity choices. Children, however, may benefit the most, as their vocation is play, Radocy said.

“We are able to allow children to participate and be a part of teams,” he told O&P Business News. “That helps build a tremendous amount of self-esteem and confidence with young kids when they can participate competitively with two-handed kids.”

“It has been my opinion all along that individuals like Bethany Hamilton and Aaron Ralston – along with countless other athletes and active individuals – have heightened the awareness of the community with regard to the role that prostheses can play in recreation and the pursuit of other activities outside the realm of typical activities of daily living,” Alley said. “Even though Bethany’s limb length and surfing focus ultimately led her to choose not to wear a prosthesis – a decision I was completely in agreement with – she brought awareness of the zest for life she had to people around the world.”

He said that the addition of L6704 has impacted the mindset of wearers and potential wearers more than anything else.

As a developer of upper limb prostheses specializing in sports and recreation, Radocy believes that traditional prosthetic equipment does not meet the needs and the demands of these environments.

“For all we hear about the great bionic hands that are being made, they are not used in sports and recreation,” he said. “They can’t come close to performing and duplicating the kinds of biomechanical movements and energy storage that is needed to swing a bat or a golf club.”

He also has found that active adults are willing to invest in a prosthetic device specifically built for just a few activities.

“As an adult, you probably only have one or two things that fall into your scheme of lifetime sports, unless you are very active,” he said. “You are willing to invest in a prosthesis that allows you to perform well, even competitively, in those one or two activities.”

It is for these reasons that the new L-code is necessary, Radocy said.

What is in store

Farquharson envisions a more positive movement in the direction of adaptations for sports and recreation as a whole, seen in part through the creation of an additional code for upper extremity assistive devices.

“Although we were lucky that the CMS created L6704, we actually were intimately involved in the issue of another code, which was also new for 2007,” he said. “L6624 was issued as a result of our application for a code for the N-Abler II assistive device.”

Texas Assistive Devices lobbied for the creation of this new code, which covers an upper extremity addition, flexion/extension and rotation wrist unit.

The application was rejected by CMS a few times, but after attending the public meetings sponsored by CMS, the applicants made further presentations for the board’s consideration.

“Although the CMS generally does not reverse any decisions, they did in our case, and code L6624 now covers the N-Abler II,” he said.

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Stephanie Z. Pavlou is a staff writer for O&P Business News.

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