Wiki Billing L3020 X2

[Lawschick]

Hi everyone,

I work in an Orthopaedic office and they give out DME L3020's as bilateral all the time; however, most of the time the Dx codes are only for Lt or Rt, which gets denied often.

From the very beginning I've been told that they have to give both left and right no matter if they are treating for only one side. I have asked many people and tried many variations of billing it but have never been able to get it fully paid.

I am very frustrated at not getting anywhere with this. Is there anyone out there that can give me some answers?

First, do the pt's actually need both inserts when only one side is being treated?
Second, if yes, how am I supposed to be billing these as bilateral and actually get paid for both?
Third, would anyone like to do my DME's please? LOL

Thanks to all for any help possible!
Holly Laws, CPC-A

 

[BLUCIANI]

Medicare has very specific coverage through their Durable Medical Equipment (DME) benefits. Functional orthotic inserts are covered by Medicare only when placed in a shoe attached to a brace. Even if the provider has a separate DME supplier number with Medicare, these functional orthotics are usually not placed in a shoe attached to a brace, and, therefore, are not covered.This would need to be paid for by the patient....​

If you are sure the orthotic is covered then the billing would be.......

L3020- Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each​

When billing the functional orthotics supply code, L3020 or L3030, you must bill 2 line items to indicate both the right and left functional orthotics. While functional orthotics come in pairs, they are coded for each individual foot. The code represents only ONE functional orthotic.
CMS 1500 appropriate completion of the form in boxes 21 and 24 of the form. It should be noted that there is more than one way to complete the form.

Option on:;
is to list a line item in box 24 of the 1500 form with the proper HCPCS code in box 24D, the properly linked diagnosis code in box 24E, the total charge for both functional orthotics in box 24F and a “2” in the units box, 24G.

Option two:
is to separate the pair of functional orthotics and list them on 2 separate lines. On the first line of box 24, list the code L3020 with an RT modifier in box 24D, the properly linked diagnosis code in box 24E, 50% of the total charge for the pair of functional orthotics in box 24F, and do not use the units box, 24G. On the next line of box 24, list the code L3020 with an LT modifier in box 24D, the properly linked diagnosis code in box 24E, 50% of the total charge for the pair of functional orthotics in box 24F, and place a 1 in the units box, 24G.