11/11/2021

Healthfirst Denial for L3000

we got a denial from Healthfirst on L3000 CAN I FAX YOU THE PAPERS IT SAY PREFAB JUST AS GOOD AS CUSTOM,,ETC... FIRST I EVER GOT THIS THX 

The denial is very straightforward from Healthfirst based on the scanned documentation- the plan will only authorize custom orthotics under the following two conditions:

• Stretching of the calf muscles and plantar surface through physical therapy or home exercises
• Billing L3010 or L3030 before billing L3000 or L3020

You will have to comply with the two prerequisites if you want to (eventually) dispense orthotics to this patient. If you have proof that more conservative treatment options have not worked, it should be submitted to Healthfirst for consideration.