01/07/2019

Healthfirst-L3000-Guidelines for Reimbursement/Payment

Health First has been denying code L3000. They now require me to bill for code L3010 or L3030. Can I bill for L3010 and L3030 by using a cast of the patient's feet and sending the casts to the lab to make the orthotics? If I can not bill L3010 and L3030 using the casting method, can I bill for them using prefabricated plastizote orthotics that I heat up and mold to the patients foot?

Effective July 01, 2018, providers can no longer call in authorizations to Healthfirst for DME; the online authorization request must be used.

Exchange products, Medicaid and Medicare policies require authorization for L3000 and always have. Again, the only change is that previously, one was able to call in the authorization and now it must be done online.

If you have any questions regarding this change you can call Healthfirst’s Medical Management department at 888.394.4327

If an authorization is not obtained, the service will not be covered by the HMO.