Wiki Need help billing Noridian/mdcr for Patella Stab brace

[MMadrigal]

Does anyone have suggestions how we are to bill the mdcr plans for the Neoprene Patella Stabilizing braces? Even if the insurance is not going to reimburse us, we would like to be able to bill the patient. We do have them sign an ABN while in office, but the rejections from the ins co. indicate we cannot bill pt. Many of them are rejecting as "invalid procedure code". We are using A4466, submiting a copy of the clinical note, and also a copy of the manufacturers invoice. We are using modifer GY. Any suggestions would be greatly appreciated. Can we just sell the brace to the patient, letting them know their ins. will not pay for this brace? Thank you in advance. Mary MMadrigal@hawaii.rr.com

 

[inc1961]

I am also interested in this information. It's now 2014 and still no answer has been posted. We billed A4466 both with GY and NY but still no payment and no patient responsibility. Has anyone had success billing braces?
Thank you!

 

[klamond]

When I looked up the code A4466 in our coding system, it states "not covered by Medicare as of 01/01/2010". You can have the patient sign an ABN and use GA modifier. That advises Medicare that you have notified the patient that they are receiving a non-covered item and in turn the denial you should get from them should state patient is responsible.