Medical Billing Forum

General Category => General Questions => Topic started by: csbilling on February 22, 2011, 02:37:47 PM

Title: Spinal Bracing and Orthotics
Post by: csbilling on February 22, 2011, 02:37:47 PM
We have a new client that specializes in Spinal Bracing and Orthotics. They are not MDs but rather fitters of these types of devices. They are teaming up with particular doctors for referrals (Dr. is writing script) and sending them on to this vendor for the devices. We are in the process of getting them accredited and contracted with Medicare, etc. In the meantime we are filing out of network for them.

What type of billing would this be under? What claim form would be filed? UB04? CMS1500?

Anything special we need to be aware of?

Thanks in advance!

Title: Re: Spinal Bracing and Orthotics
Post by: Michele on February 23, 2011, 07:27:59 AM
Without knowing exactly what they are billing there is no way to be sure, but it sounds like CMS 1500 billing.
Title: Re: Spinal Bracing and Orthotics
Post by: csbilling on February 23, 2011, 08:57:30 AM
They are billing L codes for spinal bracing.
Title: Re: Spinal Bracing and Orthotics
Post by: pattil88 on February 23, 2011, 09:27:43 AM
I agree w/Michele - sounds like they're a DME supplier and get billed w/a 1500 form. Just watch for Medicare where your DME claims s/b filed - in Georgia they are filed directly to DMERC and not through the regular Part B Carrier like the rest of the Medicare claims.
Title: Re: Spinal Bracing and Orthotics
Post by: csbilling on February 23, 2011, 09:46:01 AM
Yup, got it! I was just wondering since they are not a true MD and more like a Vendor of supplies (DME supplier). We are in NM and our Medicare DME claims go through Cigna DME.

Thanks!