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Wiki Surgical Shoe

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PLAIDMAN

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I have a commercial payor who is stating that they will not cover orthotics for a pt. because they already received orthotics in the form of surgical shoes.

I billed L3260 surgical shoe, payor is stating those are orthotics.

Can anyone help me with some documentation stating the definition of a surgcial shoe???
 
PLAIDMAN said:
I have a commercial payor who is stating that they will not cover orthotics for a pt. because they already received orthotics in the form of surgical shoes.

I billed L3260 surgical shoe, payor is stating those are orthotics.

Can anyone help me with some documentation stating the definition of a surgcial shoe???
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We inform the patients at the time of the visit that insurance most likely does not cover these shoes so the patient pays us 20.00 at the visit for the shoe.
 
Thank you for your response...but.... we do not bill surgical shoes to medicare but we will bill them to commercial insurance and we already did and we already got paid.

The problem is now the pt cannot receive custom orthotics because the payor is calling the surgical shoe an orthotic.

I cannot believe a surgical shoe constitutes an orthotic, but I cannot prove that.

My question is can anyone direct me towards documentation so I can prove that.

Thanks!
 
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