04/25/2022

Proper Billing for Orthotics

I never had a problem billing for orthotics until now. They said L3000 is part of a leg brace. What is the correct code for orthotic inserts not connected to a leg brace?

The reason Medicare stated that L3000 is part of a leg brace is because, from a Medicare perspective, orthotics are considered a statutorily excluded benefit unless they are a component of a leg brace. (Please refer to the LCD policy) The fact that you never got denied before would also need to be addressed as to how you were billing L3000 to Medicare.  You would however need to append a GA or GY modifier to receive a Medicare denial with PR (Patient Responsibility) in order to bill the secondary or patient.