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Custom made orthodics

  1. #1
    Default Custom made orthodics
    Medical Coding Books

    My Podiatrist wants me to find out if there is any insurances that pay for custom made orthodics. I know that Medicare won't but wondering about commercial insurances. Our clinic is owned by the hospital and we don't have a DME license and they aren't planning on getting one. Can anyone shed any light on this for me. I'm new to podiatry and really not sure what to tell him. I want to find out if you need a DME license in order to even bill for them before I spend any time calling insurance companies. Hope this doesn't sound like a dumb question.....


  2. #2
    High Point, NC
    Unfortunately it will vary from payer to payer. In my experience, you don't need a separate DME number for most commercial payers; however, you will still need to call them to determine if your patient has coverage for the custom orthotics. Some commercial payers will even vary depending on how the policy is written for the specific group (employer). Hope this helps some.
    Cindy Gallimore, CPC, CENTC

  3. #3
    Thanks....What is the CPT code for making the orthodics? Is it a HCPCS?

  4. #4
    Default HCPCS for orthotics
    L3030 I know BCBS pays but you have to ask them for their allowable amount or get an authorization for a set price.

    When the front office verity's each patient I added to see if dme is covered and as well as what's the allowable we always ask for, CAM, ANKLE BRACE, ORTHOTICS.


  5. #5
    Insurance companies vary between companies to even the policies with the same insurer. Do document prior authorization or precertification to fight denials get the patient involved. At the office I work at we have patients sign an orthotic waiver so if insurance denies the claim the patient accepts responsibility to pay for the custom orthotic.

    HCPC for custom orthotics: L3000, L3001, L3002, L3003, L3010, L3020, L3030, and L3031.
    Tammy Hulsey-Ferguson, CPC
    Past President AAPC Wichita, KS Local Chapter

  6. #6
    So, basically I should have the front office staff do a prior authorization for custom made orthotics. So, once he molds the foot and sends it off to be made, what do I charge when the patients come back in; the L codes?

    Just to confirm-We don't need a DME license to bill the L codes?

    Can you give me a ball park range on what you charge out for the orthotics?

    Thank you for all the information.

  7. #7
    We check benefits for every patient wanting custom orthotics. We bill L3020 RT and Lt and bill 200.00 each. We also billing for casting supplies and strapping charges. If the orthtoics are not a covered benefit- we write off the charges for casting material and strapping charges and charge the patient 400.00. We also have all patients sign an orthotic waiver. Hope that helps.

    Allysun Ghast

  8. #8
    Do get a prior authorization on custom orthotics. The only time you need a DME license is when you bill durable medical equipment to Medicare. If you have Medicaid patients you will need to be allowed to dispence custom orthotics according to your contract. For the practice I work for we do send those patients to a prosthetics/orthotics store.
    Tammy Hulsey-Ferguson, CPC
    Past President AAPC Wichita, KS Local Chapter

  9. Default
    please help, I am looking for new code A4590 fiberglass material. this procedure was deleted September 31, 2001. does any one know a new code for fiberglass material

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