03/12/2018

Proper Coding for Surgical Shoes When Billing Commercial Insurances

In general, are offices billing the patient for a surgical shoe or submitting a claim through the patient's commercial insurance? If submitting through commercial insurance, is the code L3260?

If the patient has Medicare or Medicaid, this should be billed as a self-pay item since it is not a covered item under either insurance program. If a patient has commercial insurance, some plans may cover the surgical shoe- when eligibility is checked, if the patient’s plan provides coverage for this item, it should be billed with HCPCS code L3260.