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dispensing orthotics/braces

  1. #1
    Modesto, CA; Central Valley Chapter
    Default dispensing orthotics/braces
    Medical Coding Books

    How would the following scenario's be handled in your opinion?

    Patient calls and requests new wrist brace; hers has worn out, she has not seen the physician in 1 1/2 years.
    -does she receive the new wrist brace and her insurance is billed?
    -does she need to see the physician before the brace is given and billed?

    What if the patient calls and requests the new brace because she lost her brace; which she has had for a few months.
    -In this scenario would the patient be liable themselves or would you still bill their insurance?


    Tina Reich, CPC, CPC-I, CEMC

  2. Default
    Hi Tina,
    If the pt has not seen the physican in 1 1/2 yrs... yes the pt should see the physician again. I would assume a carrier would not pay for the DME if the pt has not been seen and evaluated for continued medical necessity of the brace.
    If the pt lost the brace, you should check with the insurance carrier first before dispensing and billing. Therefore if the carrier refuses payment for a replacement, you can inform the pt before receiving the brace that he/she would be responsible and what the fee would be.

    Have a good one!

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