Wiki Physician casting for custom orthotics

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sloseke

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Hello!
We have a physician who is a foot and ankle specialist. He has been sending patient's to our therapy department for casting molds for custom orthotics. He wants to start doing the casting himself in clinic. Would 97760 be the appropriate code for this or is there a better code?
Thanks in advance for any input!

Sally Cookman, CPC, COSC
 
In the organization I work for, we have found that 97760 was not the appropriate code because the provider is molding the castings and that is it during the orthotic casting visits, and not actually managing the orthotic castings. Rather, we use A4580 and L3030 for the supplies.

Ann Lilly, CPC, COBGC​
 
Casting for Custom Orthotics

We code L3000,1 for adult and L3000,2 for pediatric custom molded orthotics. Our Physicians are casting the patients and then we send the molds out to be created, which we then disburse. 99% of the time this is a non-covered benefit (rare occasions diabetics and a few federal BCBS plans will cover) so we have the patients pay in full at the time of service.
 
Our physician who still does his own casting bills out CPT code S0395 Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic. We bill for both RT and LT

Lay Term
This code covers the preparation of a cast of a foot by a practitioner rather than the orthosis manufacturer.

Clinical Responsibility
Report this code when a practitioner 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. The practitioner may employ various materials for impression casting, with plaster the most common. Report this code for casting by a practitioner and not by the manufacturer of the orthotics, devices that help a patient regain normal functioning.
 
Can you bill A4580 and S0395 together. My physician has been trying to use both and we are seeing usually the cast materials get denied . Also since they are done bilateral should we be doing 2 lines items for both codes or can we use 2 units esp for the A4580?
Thank you
 
Jsnjs03 said:
Can you bill A4580 and S0395 together. My physician has been trying to use both and we are seeing usually the cast materials get denied . Also since they are done bilateral should we be doing 2 lines items for both codes or can we use 2 units esp for the A4580?
Thank you
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A4580 should not be used for orthotic casting. This code is for the supplies used in applying a cast or splint for the treatment a fracture or sprain or similar. Some payers will pay S0395, others do not. I have found that many will pay 29799x2 for the casting of the orthotic if you put the description of the service in box 19. Remember, the casting should be billed out at the time of service and the orthotics (usually L3000 are billed out at the time of dispense). Orthotics are not covered by Medicare unless they are attached to a covered brace.
 
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