04/01/2020

Correct Billing for L3000-Commercial Insurances, Medicaid Managed Care Plans

Can you bill for L3000 to private insurances and managed medicaids without DMEPOS license? I am currently in process of DME license. Billing L3000 but getting some denials. Also, when billing L3000 it should be One unit per foot per billing line; RT and LT, with KX modifier per foot correct?

It is not a requirement for a podiatrist to have a DME license in order to bill for orthotics or any other supplies. It is a requirement for certain insurances, whether commercial or Medicaid managed care, that a provider needs to be a DME supplier in order to be reimbursed for orthotics. Provider manuals should be reviewed to determine if podiatrists are allowed to dispense items or if the patients need to be referred to a participating DME provider in order for the purchase to be covered.

Typically, when billing insurance, two line items should be billed for HCPCS code L3000. Each line item should have the site modifier to distinguish between left and right for one unit of service. Few insurances require two units on one line item with either no modifiers or with the LT & RT modifier on the one line.