How do you get paid for Footshell replacements? Responses.

How do you get paid for Footshell replacements? Responses.

Thank You to all who Responded to my Footshell question. We will try some of
these options.

Here is a list of Responses:

Jeff,

With regard to your question about a labor code for billing a half-hour of
labor, there is L4205 (Repair of orthotic device, labor component, per 15
minutes). Use this at 2 units. Make sure to include a complete
description of the labor performed to justify billing for 30 minutes. This
code has a similarity of the 'Not Otherwise Specified' or '99' codes being
as they have to be priced by hand by the Medicare payer. This is why you
need to give them a complete status of the work performed.

Billing for the replacement component, use the code for billing the
original and add the '-RP' modifier. Also, be sure to include detailed
information to the payer explaining why this had to be replaced. It is
helpful, if you have the means, to include a photo of the damaged device to
demonstrate to the payer that it is absolutely ineffective for this
patient. If you're in DMERC Region D, you will have much more difficulty
getting a damaged item replaced if it is being replaced sooner than 5
years. I recommend that you definitely follow through with any appeals and
fair hearing opportunities, as Dr. Hoover, the Region D Medical Director
has said that items that are irreparably damaged can be replaced. Region D
just asks for every piece of documentation, including the physician's
notes, to justify that this patient's condition is what you are billing
for.

If you have any further questions, please let me know.

Karyn E. Schibanoff
Reimbursement Specialist
AOPA
1650 King Street, Suite 500
Alexandria, VA 22314
Phone: (703) 836-7116
Fax: (703) 836-0838
E-mail: <Email Address Redacted>
Web site: www.opoffice.org/aopa


Jeff I saw your question on the list serve and I have a couple of questions.
Are you seeing the wear on the planter surface of the foot shells or
somewhere else? Do you find that it is in certain size ranges or is it
universal? Please feel free to give me a call and I will try to help you,
and understand your situation. I have only seen this with a few patients and
I am curious if there is a pattern to the problem. I don't have any good way
of reimbursing for the replacement shell but I may be able to help you with
keeping the shells intact longer which is the real problem as I see it.
         Michael Link at College Park 1-800-728-7950


You should be able to bill via 999 or 52 modifier codes with an accurate
description of what you are doing. You could include an invoice for the
part, mark it up 50% percent and add a portion for your labor. And then wait
for Hell to freeze over.

Bob Brown, Sr. CPO, FAAOP