- July 15, 2024
- Posted by: David Wilson
- Category: Orthotics Billing

There are a number of provisions to work with new and recurrent patients if you are an orthotics and prosthetics supplier. The patient must provide you with a clearly written prescription for the device. The appointment with the doctor has to be within six months, and has to be specific to the need of the service.
- For example, if a patient with a cold asks for a back brace while there is no apparent need, the medical necessity has to be clearly written in the clinical notes for the payment to be realized on time.
- Also for an existing patient and in need of a recurring item, the faxing of the prescription request has to be done at your end but the item cannot be given unless the prescription is determined.
- Beginning from 2022, the Medicare benefit category and the determination of payments for new items are done twice a year after the receiving of the public comment along with the HCPCS Level II decisions with coding.
The payments are based on a fee schedule amount and different floor limits and ceiling are established for different categories. That is where a decisive partner with a comprehensive understanding of orthotics and prosthetics billing can actually help you find the right balance.
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