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halebill

halebill

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Capital Coders, Columbia, SC
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For 2010, CMS has eliminated payment for orthotic devices/braces with elastic. For example, in the 2010 HCPCS book, codes L1800, and L1825 have been deleted. Replacement codes are not offered. What if we still dispense these items? Should we try a non-specific code, or does this make the items 'over the counter'? Thanks.

Bill Hale, CPC
 
Elizabeth,

Click on the link posted by Rebecca. L1901 is included on the list braces, orthotics, belts, etc., which contain elastic material and are now categorized together under the non-covered code A4466. These items are now over-the-counter.

Bill Hale, CPC
 
So, how are you handling the billing of these codes since they are combining different priced supplies(in my system) under the "A4466" umbrella? I understand they are non-payable now but I believe we will still be supplying them to the patient.
 
anance

Just checking comments on the L1800 code. Thanks for giving the replacement code! I was needing it to bill a claim just NOW!
 
efuhrmann said:
So, how are you handling the billing of these codes since they are combining different priced supplies(in my system) under the "A4466" umbrella? I understand they are non-payable now but I believe we will still be supplying them to the patient.
Click to expand...

Liz - when the supply is given to the patient, the fee for that specific supply has to be written on our charge sheet along with the description to be entered into the system. So we don't have a "set" fee for A4466, it has to be provided by the physician (they are given a list of these supply fees to choose from). Hope that helps. ;)
 
Dme l1800 & l1815

Since codes L1800 & L1815 have been deleted, what codes should be used in their place?
 
patient billing

montie99 said:
So can we bill the pt for these?
Click to expand...

We have every patient (except Medicare & Medicaid) sign an agreement that explains the orthotic may not be covered by their payer, is not returnable, and acknowledges they are ultimately responsible for payment. These agreements are kept on file in our back office and will ultimately be scanned into our EMR system.

When implementing A4466, we used the fee for the highest priced article but enter the type of orthotic in our narrative field for the claim. This is working for us.

All Medicare patients must sign an ABN and we bill their orthotics with the GA modifier. For Medicaid patients, we do our best to get a prior authorization but lots of money walks out the door. This remains one of my biggest frustrations.
 
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