06/15/2023

1199 Denials for L3000 and L3020

We are having an issue with 1199 and payment for orthotics. I have attached EOBs that state the following as the reason for denial: Contractual Obligation - This service/equipment/drug is not covered under the patient's current benefit plan This reason for denial is for both L3000 and L3020

The claim was denied by 1199 because it was billed with the incorrect place of service code. The orthotics need to be split from the office visit and billed on a separate claim. On the new claim, the orthotics need to be billed with POS 12 instead of 11. Once the claim is corrected, payment should be made for each dispensed pair.