08/15/2019

CPT Codes for Post Op Shoes-DMERC

Where do I get the CPT codes that are allowed when dispensing a post op shoe for DMERC?

There is only one HCPCS code that is appropriate for a post-op shoe (L3260, surgical shoe, each). Like orthotics, this item is a statutorily excluded benefit by Medicare and DME and will not be covered under any circumstances. The line item needs to be billed with a -GY modifier in order to bill the patient or transfer the balance to a secondary insurance for potential payment by a private insurance or Medicare supplement plan, if it has a benefit for non-covered Medicare services.