Insurance Billing codes...L0100 vs. S1040

[Guest guest]

Hi All,

I just wanted to share some info regarding the insurance codes. I

was researching how the billing is done as I was preparing my appeal

to UHC today.

It seems to be that there are 2 codes that can be used to the

helmet. One is a medicare approved code L0100, and the other is a

generic insurance code S1040. (Neither are approved by our UHC plan

but there is a difference.) The L0100 code by UHC's definition is

for the crainial remolding orthosis only, it seems. The S1040 code

is for the crainial remolding helmet and all necessary appointments,

adjustments and scans/castings.

What I am wondering is if this is why some of you are only approved

for the approximately $600 of reimbursement. If it was billed as

the L0100 you are only being paid for the band, NOT the

appointments, etc.

Perhaps some of you could check to see if additional billing codes

are required for the full reimbursement.

Good luck on your fights with the insurance. I'm praying we will

win our appeal. I guess I should finish it and send it in first??!!!

- Boise, ID