Podiatry Coding & Billing Alert

Question: What is the correct way to handle custom orthotics that the patient does not pick up? We cannot use them for anyone else as they were custom-fitted to the patient. The patient does not respond to our calls. Can we get reimbursed for these items as salvage and cover time and expenses for them that way?

AAPC Forum Participant

Answer: In situations where a patient doesn’t pick up custom-fitted durable medical equipment (DME) such as orthotics, “Medicare allows payment in three specific circumstances:

1. “Death of the beneficiary; or,

2. “Cancellation of the order by the beneficiary; or,

3. “A change in medical necessity for the item such that it is no longer suitable for the beneficiary’s medical condition,”

according to Dr. Stacey Brennan, medical director at CGS Administrators, LLC, the DME MAC (Medicare Administrative Contractor) for Jurisdiction B (Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin) (www.cgsmedicare.com/jb/education/video/mm/salvage_claims_JB.pdf).

Based on these criteria, Medicare will not reimburse you on a salvage claim in situations where a patient simply does not pick up the orthotics. Private payers may or may not have adopted this policy, so you should be clear in advance whether they are following suit.

Here’s how to ensure payment: Some payers, such as California Medicaid, want orthotics billed at the time of casting. This will at least help you recoup some of the costs. To do this, use 29799 (Unlisted procedure, casting or strapping) or S0395 (Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic), depending on payer preference, on 2 lines with RT (Right side …) and LT (Left side …) modifiers as appropriate, again depending on payer preference.

At the same time, assuming the payer allows you to take deposits, you should take a deposit from patients with commercial plans, which will also help you recoup costs in the case of a no-show. If the payer denies payment for the orthotic, you can easily refund the deposit minus any patient contract obligations that may exist in the payer’s plan.