Podiatry Coding & Billing Alert

Question: We bill to Medicare for our podiatry services. Our podiatrist has to attend fracture patients regularly. Does Medicare pay for these services?

1. Supply of a foot insert.

2. Impression casting for a patient.

3. Supply of casting material.

Washington Subscriber

Answer: If your podiatrist supplies a foot insert, you will be looking at a code such as L3020 (Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each). This code covers the supply of a removable foot insert fabricated from a model of the patient’s own foot, i.e., a replica or electronic image. The code also includes the fitting and adjustment of the insert to support the metatarsal area and arch. Medicare will cover this device only if it is an integral part of a shoe and is permanently attached to a brace. L3020 is typically paid with a medically necessary diagnosis. To report the supply of an insert that supports longitudinal arch, you should use code L3010 (Foot, insert, removable, molded to patient model, longitudinal arch support, each). L codes also cover the fitting, adjustment, and other services associated with the device, so those services should not be billed separately. To report casting procedure for custom made orthotics, you should opt for code 29799 (Unlisted procedure, casting or strapping) in conjunction with the orthotic code.

For the preparation of a cast of a foot by your podiatrist, you should use S0395 (Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic). You will report this code when the provider casts an impression of a foot to be used to create an orthotic shoe or insert to correct a foot deformity, alleviate pain due to the foot condition, or prevent further damage to muscles and nerves. However, Medicare will not pay for this service as Medicare has provisioned this code only to implement policies, programs, or claims processing and meet their particular needs.

For supply of casting materials, you can report A4580 (Cast supplies [e.g., plaster]). This code is reported for the supply of materials, such as plaster of Paris, used to construct a cast to protect a fracture, dislocation, injury, or open wound. Besides plaster of Paris, cast materials include bandages or fiberglass wraps which remain rigid, semirigid, or flexible. Again, Medicare does not reimburse for this code.