11/01/2017
Billing for Custom Foot Orthosis-Casting & Dispensing
When can you bill for custom foot orthosis? When you cast or dispense? Is it fraud to bill out the orthotics the day you cast as opposed to the day you dispense? If so what happens if your patient agrees to the orthosis and changes their mind after you already had them made and the patient refuses to pick them up? Who is responsible for the lab fees. I have a local orthopod PA that wants to make a patient orthosis 2 months after I made them for the same patient (but never came back for follow up for our dispensal), and he called me and accused me of fraud for billing out orthosis the day they were casted. Insurance company is empire. Thank you
Orthotics are billed to the insurance companies upon dispensing. It is not appropriate to send out a claim for products not dispensed. One must also make sure they are fitted, suitable and not substandard. When you determine that a patient needs orthotics, eligibility and plan coverage for the DME product needs to be checked. We recommend the following to be part of your protocol:
- Patient is casted and a deposit is collected (refunded once insurance pays).
- Patient returns for orthotics pick up and claim is then submitted to insurance company for payment.
Some insurance companies actually pay for casting and casting supply in addition, to the orthotics, other carriers may only pay for the orthotics only and include casting in that fee.
Scenario as follows:
1st Visit: (Casting)
29799 RT Approx Charge $75
29799 LT Approx Charge $75
A4580 Plaster Cast Material x 1 unit $75 or A4590 Fiberglass Cast Material x 1 unit $75
2nd Visit: (Dispensing)
L3xxx x 2 units