Medical Billing Forum

Coding => Coding => : jennifer8055 April 15, 2014, 05:54:25 PM

: L3000/DME - Medicare????
: jennifer8055 April 15, 2014, 05:54:25 PM
Ok......any DME billers out there??  I have always been under the impression that Medicare did NOT cover L3000 (custom foot orthotics) and we never billed Medicare for the few patients that get them.  But recently, in looking at the DMERC fee schedule, there is an allowable for L3000 (not that it means they're covered, of course).....in looking at the LCD for orthopaedic footwear from Medicare, there's very little verbage about the L3000, no specific diagnosis codes that are covered, etc.

Does anyone have any information or experience with Medicare paying for L3000's ??  We've had one patient that we billed for them and they were paid for, but I'm really wondering if Medicare is going to come back and recoup this money because they've paid it in error.  The patient had Rheumatoid Arthritis and a couple of other diagnoses.....which are not on the list.....but who knows??

Thanks for information :)
Jennifer
: Re: L3000/DME - Medicare????
: Billing2 April 15, 2014, 07:04:47 PM
It's been a  long times since I billed Medicare for foot orthoses.

I hope this helps.
HCPCS 2014 Code : A5513 : For Diabetics Only, Multiple Density Insert, Custom Molded From Model Of Patient's Foot, Total Contact With Patient's Foot, Including Arch, Base Layer Minimum Of 3/16 Inch Material Of Shore A 35 Durometer Or Higher), Includes Arch Filler And Other Shaping Material, Custom Fabricated, Each
: Re: L3000/DME - Medicare????
: kristin April 15, 2014, 09:42:09 PM
I bill exclusively for podiatry, and here is the language from one of the DMERC's I bill to(NGS), concerning coverage for L3000:

"(L3000-L3170, L3300-L3450, L3465-L3520, L3550-L3595) are covered if they are on a shoe that is an integral part of a covered brace and if they are medically necessary for the proper functioning of the brace. Shoes and related modifications, inserts, heel/sole replacements or shoe transfers billed without a KX modifier will be denied as noncovered because coverage is statutorily excluded.

According to a national policy determination, a shoe and related modifications, inserts, and heel/sole replacements, are covered only when the shoe is an integral part of a brace. A matching shoe which is not attached to a brace and items related to that shoe must not be billed with a KX modifier and will be denied as noncovered because coverage is statutorily excluded."

So, unless the orthotic is in a shoe that is an integral part of a brace, it is not covered. I would check with the DMERC you bill to, to see if they have a different policy, but it is doubtful they do.
: Re: L3000/DME - Medicare????
: jennifer8055 April 17, 2014, 04:27:28 PM
thanks for the info......those were the only responses i found in medicare lcd's as well.......was hoping someone else had a better experience.  i'm guessing the one patient i have that dmerc actually paid on L3000's i should be expecting a refund request any day for that.

thanks!
jenn
: Re: L3000/DME - Medicare????
: royagma November 16, 2022, 12:36:59 AM
<a href=https://lasix.autos/>lasix drug class</a> 70 1987 789798 PubMed ISI Google Scholar 39 Tohei A
: Re: L3000/DME - Medicare????
: unorgobug November 19, 2022, 03:29:05 AM
The study aims to better understand the derivation, generation and composition of enteric neurospheres <a href=http://doxycycline.world/>doxycycline side effects for dogs</a>
: Re: L3000/DME - Medicare????
: Vogegrorb December 07, 2022, 07:30:40 AM
<a href=https://ccialiss.icu>tadalafil cialis</a> Benign breast disease, recent alcohol consumption, and risk of breast cancer a nested case control study
: Re: L3000/DME - Medicare????
: piegmen December 09, 2022, 05:35:05 AM
The parties agree that the benefit plans are governed by ERISA <a href=http://lasix.one>lasix 12.5</a>
: Re: L3000/DME - Medicare????
: awaixebra December 13, 2022, 05:16:10 PM
<a href=http://sviagras.cyou>is viagra bad for you</a> click mieux enseigner comment devenir pediatre coupe schГ©matique de l oeil pupille yeux terminologie mГ©dicale cardiologie brassage gГ©nГ©tique et diversitГ©
: Re: L3000/DME - Medicare????
: lapound December 15, 2022, 07:35:47 PM
For these reasons, most cardiologists prefer electrical cardioversion, which involves being placed into a light, anesthesia induced sleep for a few minutes, during which time a quick and painless electrical discharge is administered to the chest with a set of paddles <a href=http://stromectol.mom>stromectol for pinworms</a>
: Re: L3000/DME - Medicare????
: Faispom January 23, 2023, 06:46:08 PM
I had started having pain and discomfort almost a month into taking the tamoxifen <a href=http://priligy.buzz>where to buy priligy</a> Herschel UNqRdWkQcoWzyMhPMCK 6 28 2022
: Re: L3000/DME - Medicare????
: easetty January 26, 2023, 12:22:28 PM
The Approved Drug List formulary is updated annually and as changes are made or new medicines are approved <a href=https://nolvadex.pics>tamoxifen generic</a>
: Re: L3000/DME - Medicare????
: stacioutt February 03, 2023, 09:44:53 AM
While there are specific dietary factors to be considered for each calculus type, there is also a general list of dietary measures that can be recommended in order to avoid any renal calculus formation <a href=http://zithromax.top>azithromycin for chlamydia side effects</a> The Chi square test was used for qualitative data
: Re: L3000/DME - Medicare????
: ideorrert February 05, 2023, 04:16:49 AM
Factors for Decision making <a href=http://accutane.buzz>comprar accutane in usa</a>
: Re: L3000/DME - Medicare????
: knomype February 06, 2023, 06:53:40 PM
085 Cremophor 750 mg solution RH 40 Peceol 150 mg Propylene 100 mg Glycol 28 Captex 355 200 mg Clear 0 <a href=http://vkamagras.cyou>us pharmacy selling kamagra</a>
: Re: L3000/DME - Medicare????
: Faispom February 09, 2023, 11:33:46 AM
<a href=http://cialis.hair>cialis cost</a> Archie eBEAPYoOCPboQt 6 17 2022
: Re: L3000/DME - Medicare????
: grospic February 14, 2023, 10:46:50 PM
<a href=http://lasix.beauty>lasix Turkey</a> PID rarely occurs in pregnancy; however, chorioamnionitis can occur in the first 12 weeks of gestation, before the mucous plug solidifies and seals off the uterus from ascending bacteria
: Re: L3000/DME - Medicare????
: Goormunny February 20, 2023, 05:16:42 AM
2007, 93 225 227 <a href=https://buycialis.buzz>legit cialis online</a>
: Re: L3000/DME - Medicare????
: Coogincot March 03, 2023, 05:13:19 AM
But all that stuff does is motivate us as players to go out there and perform better <a href=https://buycialis.buzz>buy cialis online with a prescription</a>
: Re: L3000/DME - Medicare????
: Appoink March 09, 2023, 08:34:40 PM
Dolinko, AV, Farland, LV, Missmer, SA et al <a href=http://buycialis.buzz>where to buy cialis</a>