Wiki Billing for shoes and inserts to Medicare (ING)

[Aneta]

Hi everyone! I am trying to bill to CGS Medicare for DME. The doc did 1 pair of shoes A5500 and 3 pairs of inserts A5512 for a diabetic patient. I am new to DME billing and I heard so many different versions how I supposed to do it. Previously I billed A5500 x 1 and A5512 x 3 and haven't heard fro the ins. Somebody from Medicare adviced the doc to bill A5512 RT x 3 and A5512 LT x 3, A5500 RT x 1 and A5500 LT x 1 and add KX modifies. I am confused as A5500 is counted as a pair and the same A5512. Any suggestions on proper billing?

 

[traicemoss]

If you are supplying one pair of shoes, it will be A5500-KXRTLT with 2 units. If three pair of inserts are being dispensed it will be A5512-KXRTLT with 6 units. I have been doing billing to CGS for these items for 9 years. Before appending the KX modifier make sure you have the necessary documentation to support the use.

I hope this helps.

Traice M, CPC,CPB