A patient is provided with a customized prosthetic limb and the patient dies before the supplier is able to deliver it. Can the supplier bill for the prosthetic limb?
If a custom-made item was ordered but not furnished to a beneficiary because the individual died or because the order was cancelled by the beneficiary or because his/her condition changed and the item was no longer medically necessary or appropriate, payment can be made based on the supplier’s expenses. (See subsection B for determination of the amount of the reasonable charge.) In such cases, the expense is considered incurred on the date the beneficiary died or the date the supplier learned of the cancellation or that the item was no longer medically necessary or appropriate for his/her condition. If the beneficiary died or his/her condition changed and the item was no longer medically necessary or appropriate, payment can be made on either an assigned or unassigned claim. If the order was cancelled by the beneficiary for any other reason, payment can be made to the supplier only.
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