03/06/2018

GHI-Billing for Orthotics

A patient called GHI and was told I can bill for DME. I gave the patient the ICD 10 Q72.811 and CPT L3000 Lt and L3000 Rt to inquire as I have never had orthotics reimbursed in the past. Provider Relations has been of no help. We were told to apply for DME Participation through EviCore. Is this correct? Question: Do The Above Insurances approve and pay for orthotics for a Podiatrist who is not an Orthotist? If so how and for what plans. Thanks.

A podiatrist participating with an Emblem Health Plan (GHI or HIP) can’t bill for orthotics or any other DME product, even if the item is typically under the scope of coverage for podiatry. Emblem Health requires all members who need DME supplies to have a prescription written by the referring physician, to be given to a participating DME provider within the patient’s network. The DME supplier would need to furnish the items to the patient in order for orthotics, diabetic shoes, or any other equipment to be covered. If a podiatrist bills DME items to GHI or HIP, the claim will be denied for a provider specialty exclusion and the patient may be responsible for the full amount of the bill. GHI never pays for L3000. When there is no Medicare involvement and when credentialed only as a podiatrist, DME and podiatric surgeries are not payable.