Podiatry Coding & Billing Alert

Question: Our pedorthist saw a patient to go over their footwear and feet to determine the proper medical grade insert that would work with their foot type. Can they bill 99211 for this?

AAPC Forum Participant

Answer: Because the person performing the service is an allied health professional, not a medical doctor, it would be appropriate to bill 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional) for the consultation with the pedorthist.

Assuming the practice is a certified durable medical equipment (DME) provider, they will also be allowed to bill L3000 (Foot, insert, removable, molded to patient model, ‘UCB’ type, Berkeley Shell, each) if the pedorthist creates custom foot orthotics for the patient. Be sure to add modifiers for the right (RT) and left (LT) inserts to be reimbursed for both.

Editor’s note: Code 99211, also known as the “nurse visit” code, doesn’t require medical decision making (MDM) because it is designed for situations where the services are minimal and don’t require the direct involvement of a physician or other qualified healthcare professional (QHP). Instead, the code usually reflects services performed by a nurse practitioner (NP), a physician assistant (PA), or any other nonphysician practitioner (NPP). Even so, the use of 99211 should still be supported by documentation in the patient’s medical record, like any office or outpatient evaluation and management (E/M) visit.

Certified DME providers are able to bill for custom orthotics using any of the following codes:

• L3000 (Foot, insert, removable, molded to patient model, ‘UCB’ type, Berkeley Shell, each)
• L3001 (… Spenco, each)
• L3002 (… Plastazote or equal, each)
• L30003 (… silicone gel, each).