Podiatry Coding & Billing Alert

Question: Another coder in my practice wants to bill L3000-LT-RT for casting of orthotics, but I'm not so sure. When should we bill for this code?

Nevada Subscriber

Answer: HCPCS L3000 is a code for functional orthotic devices. It is not a code for casting for orthotics. By statute, functional orthotic devices (HCPCS L3000-L3030) are only covered if they are an integral part of a shoe which is permanently attached to a leg brace. These cases are rare, and will most likely be provided by an orthotist, not by a podiatrist.

Tip: When you're submitting a claim for functional orthotic devices, report the code with modifier GY (Item or service statutorily excluded or does not meet the definition of Medicare benefits) to indicate that you know this is a non-covered service, and therefore, a patient's responsibility.As for orthotic casting, most companies do not pay separate for it.