orthotics/casting

January 9, 2009

For those of you that cast feet for offsite orthotic fabrication, are

you having issues with reimbursement?

How are you billing for the process, from casting to dispensing the

orthotics?

We have an increasing number of payer sources that do not cover foot

orthotics unless for diabetic care. We include LE biomechanics

assessments with a major part of our outpatient population and find

purpose and good outcomes using orthotics for several problems.

We do include orthotic training at time of issue but our payers are not

covering " orthotic anything " related to the foot.

Any ideas? What is working for you? Is it now just a cash option?

Dan , PT

PT Manager

Vernon Memorial Hospital

Viroqua, WI 54665

dnelson@...

January 9, 2009

Dan,

We use code L3030. We always verify coverage prior to service. Some insurance

companies do not cover custom foot orthotics. We eval & cast the patients in

the office. We then mail the mold to Biomechanical. When we receive the

orthotics back from them, we fit the patient. We bill for the casting, and then

later for the fit, plus the cost of the orthotics. When you verify benefits, be

very specific with the insurance company. Give them the codes you use. Try to

get reauthorization from them. Try to get the benefit detail in writing if

possible. Some insurance companies have web sites that state when orthotics are

covered and what icd's are covered. Aetna is a good example. Go to their site

and search for orthotics coverage. Coverage is tricky. The trend I have

noticed is a decline in the coverage for custom foot orthotics. My PT.

Lauer does a great job at casting and the eval form. The patients are very

satisfied

with the results, and come back years later for new ones. As a heads up,

Fibromyalgia patients are very difficult to fit. We do orthotics less than a

dozen orthotics per year. You will need a prescription for custom foot

orthotics and a letter of medical necessity from the patients doctor. From the

APTA web site:

97760 Orthotic(s) management and training (including assessment and fitting when

not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk,

each 15 minutes

97761 Prosthetic training, upper and/or lower extremity(s), each 15 minutes

97762 Checkout for orthotic/prosthetic use, established patient, each 15 minutes

From some google clicks:

CPT 99002 Handling, conveyance, and/or any other service in connection with the

implementation of an order involving devices (eg, designing, fitting,

packaging, handling, delivery or mailing) when devices such as orthotics,

protectives, prosthetics are fabricated by an outside laboratory or shop but

which items have been designed, and are to be fitted and adjusted by the

attending physician.

2008 HCPCS A4580

Cast supplies (e.g. plaster)

We bill these codes most of the time we get paid for L3030, 97762, 97760, 97761,

but not always

We seldom get paid for 99002 & A4580.

That's 6 years worth of info I have, Good Luck

Lori A.

Office Manager

Holistic Physical Therapy LLC

HPTLLC@...

Phone:

www.holisticphysicaltherapymonroe.com

Serving Monroe County For Over 10 Years

Subject: orthotics/casting

To: PTManager

Date: Friday, January 9, 2009, 2:31 PM