Sykes Hernia Control Form

Chat with GenHealth to automate any policy or prior auth task.


Notes: Reimbursement for the Sykes Hernia Control will only be made when an ordinary truss would be covered and if the charge is not substantially in excess of what would be reasonable for a conventional truss. If the charge for the Sykes Hernia Control is significantly higher than a conventional truss, reimbursement will be based on the reasonable charges for the conventional truss.

Indications

(579488) Is the Sykes Hernia Control being used for a reducible hernia? 

Effective Date

01/01/2066

Last Reviewed

NA

Original Document

  Reference



Based on professional advice, it has been determined that the sykes hernia control (a spring-type, U-shaped, strapless truss) is not functionally more beneficial than a conventional truss. Make program reimbursement for this device only when an ordinary truss would be covered. (Like all trusses, it is only of benefit when dealing with a reducible hernia). Thus, when a charge for this item is substantially in excess of that which would be reasonable for a conventional truss used for the same condition, base reimbursement on the reasonable charges for the conventional truss.

Book a walkthrough

Walk through this policy with us

Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.