Picking The Right Codes for Orthotics Billing

There are several codes which providers use in billing for orthotics, and its crucial to choose the right one. There is a DMEPOS number which is not your NPI number and is required to receive the reimbursement for splints, orthotics and the other supplies.

97760 is the Orthotics Initial Encounter Code which is specific. That said, if you are using an L code you have to make sure that you are not reporting 97760.

• Hence, it quite evident that Orthotics billing is a specialized segment. It requires an effective management of a lot of activities with front office tasks like eligibility verification, prior authorization, order entry/confirmation, doctor’s office follow up.

• It actually makes sure that the post billing activities fall in line with effective submission of clean claims. Managing your denials, working on why the claims have been rejected gets lower if the pre billing part is managed effectively.

• For Orthotics, Medicare reimbursement includes it all: evaluation, measurement and fitting, fabrication & customization, materials, cost of labor and delivery. Also there are a lot of things when your patient decides to rent or purchase the item with codes like BR, BP, BU the last one reflects that you have informed the beneficiary of his or her purchase or the options of rentals, but he or she has not made a decision after 30 days.

• Also proving medical necessity with each DMERC having its own list of items requiring a CMN and these lists typically includes the following items like: osteogenesis stimulators, TENS units, wheelchairs (motorized and manual), CPAP machines, lymphedema pumps, hospital beds, support surfaces, seat lift mechanisms & power-operated vehicles.

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