Wiki Orthotics

[barelybe]

We have a Podiatrist who is a foot & ankle specialist/surgeon that makes custom foot orthotics and bills HCPC codes L3020 RT/LT for the orthotic, L2820 RT/LT for the soft top coat material and L2999 RT/LT for the rear post/wedge. He brings the patient into the office to make the plaster molds of the feet, ships them off with a RX to a Lab to make them. The Lab sends them back with an invoice that our Dr. pays, the patient is brought back to the office for a fitting and sometimes Dr. has to modify the orthotic.

We have work comp. carriers stating that because we are sending them out to a Lab, they are not custom and are wanting a copy of the Labs invoice. Once they receive the invoice they change our code to a 99070 and pay a small amount over the invoice cost rather than the OMFS DMEPOS allowable that work comp has set.

If the Lab is putting the pieces together does that mean they are no longer custom?

Thank You!
Beverly

 

[rsrizzo]

Custom Orthotics

Bevery, I also work in a Podiatrist's office who molds the orthotics in the office and sends them to a Lab. We bill L3000 RT/LT.
For the vast majority of our patients, we pre-certify their coverage with their insurance company and notify the pt of their coverage, before we mold them.
With worker's comp. claims, we always pre-certify.
Is this one particular WC carrier?
Is the Lab billing the WC carrier as well?
I would appeal and document the custom molding process. Obviously, the Lab is not 'creating' the custom orthotic; the Podiatrist is 'creating' them.
I hope this helps.
Roberta

 

[barelybe]

It is a couple different carriers and the Lab is only billing us. We also get prior authorization as well but when it comes down to the review companies, they are the ones stating not custom made after I have sent the invoice from the Lab.
Thank you for your reply Roberta
Bev

 

[rsrizzo]

Hi Bev,

Time to appeal! Document the time-consuming customizing process done in the office by the Physician and that the lab [techs] just build the device(s) to the doctor's customized specs. Include copies of the HCPCS manual's documentation/page(s) to justify your codes.

This sounds like delay tactics in an effort to not pay appropriately. Be insistent.

Good Luck and post your results.

Roberta