Cam walker

player14

Contributor
Messages
15
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0
L4360 is the code you use for the walking boot. We bill modifier NU for commercial plans, KX for Medicare (and Medicare advantage) plans - as long as you meet their medical necessity guidelines/diagnosis, with the RT or LT modifiers. If this is medicare DME, you need to bill to the DME contractor (provided you have a contract) with POS 12. Always review policies for the insurance regarding billing specifics (modifiers, POS, ICD codes), google is your friend if you have trouble finding it.

Usually these are just dispensed, so there is not really work involved in a 'fitting', but this would be included in the e/m - if you are billing one.

-Massachusetts
 

podcoder70

Contributor
Messages
20
Location
lakeport, California
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This is not the only code. There is also L4361, L4386, L4387. Look at the descriptions and choose the one that best fits the boot being dispensed. Also, with Medicare, by adding the KX modifier, you are indicating that the documentation supports the medical necessity. The documentation for DME is very specific, make sure your notes have the required information to use the KX modifier. An NU modifier is not necessary for commercial plans, just the RT or LT. The "fitting" is included in the the L code being billed.
 

pinnaclephyserv

Networker
Messages
69
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What about UHC (medicare) paying for L4360? I bill with POS 12 and KX but they keep denying all claims..

Any help is appreciated.
 

podcoder70

Contributor
Messages
20
Location
lakeport, California
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Are you billing it with RT or LT as well? Also, some carriers expect to see edema to support the pneumatic boot. Make sure too that your software has the ordering doctor on the claim.
 
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