Orthotics & Prosthetics - Question Page

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1. When billing for repairs of orthotic and prosthetic items, a new order is required.

2. The repair labor code for an orthotic device is:

3. Maintenance which may be necessitated by manufacturer's recommendations or the construction of the prosthesis and must be performed by the prosthetist is covered as a repair.

4. There are 4 functional levels in the LCD for Lower Limb Prostheses.

5. When billing a HCPCS code with the RT and LT modifier on the same claim line, the units of service should be one (1).

6. The LCD for Spinal Orthoses requires the LT and/or RT modifier.

7. An order for a lower limb prosthesis must list all components that will be separately billed.

8. The ICD-9 code that justifies the need for the orthotic or prosthetic item must be included on the order.

9. For custom fabricated orthoses (L1834, L1840, L1844, L1846, L1855-L1880), there must be detailed documentation in the orthotist’s records to support the medical necessity of custom fabricated rather than a prefabricated orthosis.

10. A separate allowance is made for the evaluation of the patient, measurement and/or casting, and fitting of an orthosis.

11. Effective for claims with dates of service on or after April 01, 2009, if a spinal garment is made primarily of elastic material, what specific modifier must be added to the code?

12. For an item to be covered by Medicare, a written signed and dated order must be received by the supplier before a claim is submitted.

13. When a custom fabricated item is initially provided that is billed with code L2999, the claim must include the manufacturer name and model name/number.

14. Use of miscellaneous code L5999 reflecting either “continuous gait assessment, computerized microprocessor controlled knee prosthesis” or “electronically controlled static stance regulator, adjustable” is not acceptable.

15. If you are unsure of the proper code to use for billing purposes, you can contact the following partner contractor for assistance:

01/15/2010