Podiatry Coding & Billing Alert

Question: My podiatrist is trying to bill an L5000 for a nondiabetic Medicare patient. The patient required a transmetatarsal amputation due to a diagnosis of peripheral arterial disease. Would Medicare still cover the forefoot filler insert even though the patient isn’t a diabetic?

Pennsylvania Subscriber

Answer:

Yes, the shoe insert should be covered. Because L5000 (Partial foot, shoe insert with longitudinal arch, toe filler) is an orthotic device, it will not be subject to the same Medicare rules as billing diabetic shoes. Due to the patient having undergone a transmetatarsal amputation, the filler insert will be considered medically necessary for the patient, and billable to Medicare. Just to be safe, however, you should include notes from the medical record to prove medical necessity and attach modifier KX (Requirements specified in the medical policy have been met) to L5000 as well to avoid a denial.