- May 12, 2019
- Posted by: Thomas Anderson
- Category: Orthotics and Prosthetics
Orthotics and Prosthetics may be subject to a co-pay or coinsurance. Payer requisites vary and authorization is required. It is considered to be a key component of the benefits provision of the member. The general billing requirements with Orthotics and Prosthetics devices will be:
? Prior to the delivery date, a prescription is required from the ordering physician
? Based on time period, limitations has to be considered within which an item is supplied earlier, can be covered. An example of this will be a pair of orthotic friendly shoes are covered in a calendar year by the Medicare!
? Use of the appropriate modifiers to be billed e.g. KX, LT / RT, NU etc.
? Coverage of devices also subject to qualifying diagnosis, E.g. Orthotic shoes not covered unless diagnosis states diabetic
? Repair, replacement and supplies may be eligible for separate reimbursement.
? Letter of medical necessity and additional documentation may be required for some devices, e.g. PPR form for prosthetic devices, Diabetic Verification Form for diabetic patients etc. It is subject to medical review by the payer
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