What You Should Know About Custom Orthotics Billing

Ensuring Maximum Reimbursement from Orthotics Billing

Billing for orthoses, which are essentially specially designed devices, such as braces or supports, to correct limb or spine disorders, may appear to be a limited field to the casual onlooker. This is probably due to the somewhat limited range of device types and treatment options, when compared to more elaborate areas of healthcare such as cardiology or neurology. In reality, Orthotics billing can be an extremely tricky affair. The use of wrong codes is a common problem encountered in this type of billing, robbing providers of their due reimbursement by insurance companies.

In order to ensure maximum reimbursement by the patient’s health plan, providers need to verify certain aspects of the coverage. This means asking the carrier some key questions in order to better understand how much coverage can be obtained for a proposed device and how much of its cost will have to be borne by the patient. Such fore-knowledge can help eliminate many unpleasant surprises down the line.

Speaking of custom orthotics billing, the provider needs to verify at the outset some key facts. These include finding out if there is a maximal limit of payout per diagnosis per year, the percentage of coverage allowed, if certain diagnosis codes are necessary for reimbursement under the policy, if a Letter of Medical Necessity is required to be submitted with the claim, if a prescription from a physician is also required, if the device in question will be included in the deductible, and so on.

Further Questions you Need to Ask

Providers who prescribe custom-made orthotics to their patients must know how to bill and code for it properly so that maximum reimbursement can be ensured. Therefore, one of the primary questions to ask the carrier is if custom-molded foot inserts are covered under the patient’s policy and if they are to be billed with code L3020. If the L3020 code is not accepted, you should try to find out if the code L3030 can be used.

Many insurance plans provide coverage for orthotics under a separate policy benefit. If this is the case with your patient’s specific plan, you need to find out all the details of how to submit the claim and how much you can expect to be paid. Remember, if the answers to the initial questions regarding the codes L3020 and L3030 are “no,” then billing for the custom-made orthotics will strictly entail a cash transaction.