Wiki L4360

[bobbyswife_2001@yahoo.com]

I need help! I work for an Orthopedic Surgeons office in Texas, and we have a stock of Orthotics that we give to the patients and we bill the insurances for them. I received a denial from Medicare for a walking boot (L4360) stating it is not a covered item. I'm really not sure if that is because we are a doctors office billing for a DME. The patient had a ORIF and the boot is warrented. Has anyone else had this issue, or should we just send our medicare patients to a DME company that accepts Medicare?

 

[LisaG81]

I'm pretty sure if you're in Texas you have to do the same thing we do in Virginia and bill any DME to DMERC (DME MAC Jurisdiction C) instead of your regular Medicare processor. We bill L4360 a lot because one of our surgeons does a lot of foot/ankle. We have to bill a KX, NU modifier as well usually.

Here's the link for more info: http://www.cgsmedicare.com/jc/index.html

 

[erjones147]

This post is very interesting to me, because as a beginning Medicare biller, I couldn't figure out why all our supplies were getting denied

As a freestanding tribal health clinic, we go through Novitas as our MAC, but would I have to enroll our facility with Noridian (our "local" MAC), with a separate 855B for our facility and 855R's for our providers?

Would this screw up my primary billing with Novitas?