Wiki United Healthcare Orthotics

[kberger2124]

My office is in New Jersey, we have united healthcare telling us that orthotics are covered for diabetic only. Has anyone come across this since the new year? Not sure if this is new guidelines?

 

[lipstick]

Which hcpcs code? and what plan does the patient have? We are in NJ as well

 

[amyjph]

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/UHCCP-Diabetic-Other-Orthopedic-Shoes-Policy-(R7105).pdf

"UnitedHealthcare Community Plan will not reimburse for diabetic shoes or orthotics provided to patients without a diagnosis of diabetes reflected on the claim. Similarly, UnitedHealthcare Community Plan will not reimburse for non-diabetic shoes or orthotics to patients with a diagnosis of diabetes reflected on the submitted claim, as there are more appropriate codes that should be utilized."

Not NJ, but info: https://www.uhcprovider.com/content...turevalue-bip/shoes-foot-orthotics-common.pdf

https://podiatrym.com/search3.cfm?id=136554

 

[podcoder70]

My office is in New Jersey, we have united healthcare telling us that orthotics are covered for diabetic only. Has anyone come across this since the new year? Not sure if this is new guidelines?

This would be plan specific in my opinion. With the Medicare Advantage plans L3xxx codes are not covered unless attached to a brace. The commercial plans, again, have specific coverage guidelines for each plans.