Orthopedic Coding Alert

Question: We billed two inserts of L3010 (Foot insert, removable, molded to patient model, longitudinal arch support, each) to our carrier with modifier -50. The insurer denied the claim. Do you have any idea what is wrong?


Florida Subscriber

Answer: You should not be using this modifier to bill orthotics. Modifier -50 (Bilateral procedure) is a surgical modifier that you should only use with CPT codes in specific situations concerning specific anatomic areas.

When billing orthotics for both feet, try billing two units on one line (L3010 x 2) or bill two lines of the insert, each with an -LT or -RT appended to the code. Ask your carriers which method they prefer.

You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic