01/11/2019

Non-Reimbursement for L4386-A Few Insurance Plans

Cpt Code L4386 is not being reimbursed by a few insurance companies, it is a walking case, is there a comparable code or another way to attain reimbursement for this code?

If HCPCS code L4386 is not covered by a small number of insurance plans, there are a few different ways to handle the denial, depending on the insurance or reason why the DME item was non-covered:

• Confirm that the walking boot is a covered DME item under the patient’s plan. Some insurances will not have coverage for DME items at all, or will not let a podiatrist dispense them to a member of the plan
• Verify if there are any restrictions with the plan for covering the walking boot. Some plans may require pre-authorization, or for a specific DME supplier to dispense the item, even if the practice is in network with the insurance
• Lastly, review the coding to make sure that the coding for the walking boot meets DME guidelines (or the insurance’s guidelines if they have their own published document)