Podiatry Coding & Billing Alert

Question: What diagnosis codes besides plantar fasciitis and diabetes are billed for foot orthotics?  

New Jersey Subscriber

Answer: As much as we may wish it were so, there are no set codes that fit all payers. And even under the Medicare program for diabetic patient therapeutic shoes, diabetes alone does not necessarily guarantee coverage: the patient still needs to meet one or more of the listed lower extremity conditions, along with diabetes, to qualify.

Use your best judgment and consider conditions you feel custom foot orthotics would be most appropriate and medically necessary. This would include many musculoskeletal conditions in the foot such as plantar fasciitis, tendinitis, instability, etc. Document medical necessity and the need for orthotic therapy. >

Check your payers’ guidelines to see if they have a published list of approved diagnosis codes. Each payer has their coverage policy for foot orthotics in terms of benefit and utilization. >