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orthotics - We have a DME number and want to bill code

  1. #1
    Default orthotics - We have a DME number and want to bill code
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    We have a DME number and want to bill code L3020 We have spent hours on the phone with Cigna DMe and are still confused. We believe this code should be billed L3020 RtKX and L3020 LTKX The lcd states we can do this if it meets medical necessity Anyone from Jurisdication C have any input

  2. #2
    We bill for orthotics almost every day. For all Medicare patients submit claims to CIGNA government services. You are absolutely right, bill L3020 KX RT and L3020 KX LT. Can't tell you anything about Dx. It depends on Insurance. Sometimes I bill just 719.47 ; 719.7, Good luck! Fill free to ask if you have any other questions.

  3. #3
    Default Orthotics
    Your coding should work.

    However, you should ensure that your code is correct. There is a great site to check your manufacturer item number against the MC system HCPCS code.

    DMEPOS is a high area of fraud and you always want to ensure you are doing it right. Some of the vendors (salesmen) recommend the incorrect code but this site will tel you whether it is correct or not (most times). Also ensure your record supports using KX. Don't just assume that it is necessary because your diagnosis shows in the LCD as they usually indicate coverage criteria.

    Also be aware that patients usually have a different level of benefits for these versus your office services based on the payer and many payers do not cover them at all. Ensure that you are giving them the code you are billing to get the benefits. You will learn a lot from that. The last thing you want is a patient calling your office about a bill that you didn't inform them or misinformed them of.

    Good luck!!

  4. #4
    Is this a Medicare patient or a Cigna commercial insurance. Medicare will not cover custom orthotics unless the orthotic is an integral part of a custom brace. If the custom orthotic is not an integral part of a custom brace then a ABN needs signed stating that custom orthotics are not a covered benefit by Medicare before the orthotic is ordered for the patient. If there is a signed ABN is on file then the patient may be billed for the custom orthotic. If this is a Cigna commercial policy then Cigna considers custom orthotics experimental and will not cover them.
    Tammy Hulsey-Ferguson, CPC
    Past President AAPC Wichita, KS Local Chapter

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