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Q4050 & L-codes!

  1. #1
    Default Q4050 & L-codes!
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    Our clinic has been having extreme difficulties getting Q4050 (waterproof) paid for any carrier (mainly medicaid plans). The clinic is in Arizona and so the waterproof is almost always a necessity because of the climate. Does anyone have any suggestions on what we can add for medical necessity (and which box it should go in on 1500?). (Many carriers also will only pay 1 unit--for this and A4590?)

    Also, virtually all of our L-codes are being denied for 'invalid or missing modifier', currently we are putting "NU" and this isn't working. Anyone know of a better modifier? (ex.
    L3265, L4360)

    Thanks so much!!
    Mallory E, CPC

  2. Default
    Hi Mallory,

    I assume the waterproof you're referring to is the Gortex lining or something equivalent. I was not aware that its covered by any insurance, but we don't have the climate you do, so perhaps they would allow for medical necessity.

    As far as the modifiers for the L codes, it depends on the insurance. Blue Shield of Mass and Harvard Pilgrim require NU, but for Medicare you have to refer to the LCD. The KO and AFO require KX and LT or RT as appropriate for our claims, but again, refer to the LCD for your Medicare jurisdiction.

    Hope this helps.

    H McIntyre

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