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L3000/DME - Medicare????

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jennifer8055:
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

Billing2:
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

kristin:
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.

jennifer8055:
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

royagma:
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