Outpatient Facility Coding Alert

Published on Mon Jun 25, 2012 PDF

Question: Do insurance companies pay for footwear in an ASC, such as surgical boots?

Answer: Under Medicare, codes for certain supplies such as L3260 (Surgical boot/shoe, each) often fall under the category of "special coverage instructions." In the instance of L3260, the supply is covered when provided in an ASC setting, but the payment is already included in payment for the primary procedure or service. Non-Medicare payers often follow suit, but some may provide additional reimbursement. Include the code on your claim, but realize that you likely won't get separate payment. Leg, arm, back and neck braces, on the other hand, are covered under Part B, but are not included in the ASC facility payment amount for ASC services. If the ASC furnishes these to beneficiaries, it is treated as a supplier and all the rules and conditions ordinarily applicable to suppliers are applicable, including obtaining a supplier number and billing the DMERC or DME MAC where applicable.