Section 92-01-02-29.7 - Prosthetics1. For the initial prosthesis, an injured employee shall obtain the primary health care provider's order of medical necessity supported by objective medical findings before the purchase of a prosthesis may be approved by the organization. The primary health care provider's order must contain the following: b. Date of patient's face-to-face examination;c. Pertinent diagnosis or conditions that relate to the work injury and the necessity of prosthesis;d. Specific description of the type of prosthetic being requested;e. Primary health care provider's signature; andf. Date of primary health care provider's signature.2. An injured employee shall undergo an evaluation and assessment by a treating provider, therapist, or prosthetist and that evaluation must contain recommendations based on medical necessity and conform to the primary health care provider's order. Medical documentation must provide the expected benefits and must explain the link to the physical injury necessitating the request.3. The organization may require additional assessments to determine the functional levels of an injured employee who is being considered for the prosthesis.4. The organization will only purchase and maintain a single prosthesis absent extraordinary circumstances. Extraordinary circumstances are determined by the organization in its sole discretion. Extraordinary circumstances may not be supported by nonwork activities.5. Initial prosthetic apparatus must be body powered.6. The organization must approve the prosthesis prior to purchase. If the prosthesis is approved, the organization shall compensate the medical services provider according to the appropriate fee schedule.7. Repurchase or repair of prosthetic apparatus will be determined by the organization in its sole discretion.8. Replacement requests for prosthetic devices must independently meet the criteria in this section.9. A minimum of two itemized cost quotes may be requested by the organization. The organization may decrease or add the number of cost quotes required.10. An appeal of a decision made by the organization under this section must be adjudicated pursuant to North Dakota Century Code section 65-02-20.N.D. Admin Code 92-01-02-29.7
Adopted by Administrative Rules Supplement 2023-391, January 2024, effective 1/1/2024.General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-20, 65-05-07