07/02/2021

UHC Denial for L3000

I submitted claim to United healthcare for custom orthotics the patient was casted using plaster splints I made a custom molded orthotic and billed code L3000 left and right this was all indicated in my note I received denial stating had to specifically state a UCB type Berkeley shell to bill code L3000 it was suggested by another colleague to use L3020 I remember we were using code 3020 for blue cross snd blue shield a few years ago and we were told to use code L3000 is there a change and what code should I bill is it based on posting etc? Thanks

I would suggest contacting the insurance company to get more information regarding the denial. What diagnosis code was used and does the patients specific plan cover them for orthotics.  HCPCS L3000 for orthotics is a payable code by commercial and Medicaid plans for many conditions. In some cases, the plan will request supporting documentation to justify the medical necessity of the charges. With the documentation that was submitted, it’s suggested to discuss what information was missing from the notes that caused the claim to deny. No changes to the coding is necessary if the documentation supports the procedure codes billed to the insurance.