US Billing Question, HCFA payment for TLSO socks
Description
Collection
Title:
US Billing Question, HCFA payment for TLSO socks
Text:
As most of you know, I manufacture and sell a cruciform hyperextension
brace. Along with it I sell a specially-made TLSO sock to wear under it. I
have been recommending for orthotists to supply two of those socks with each
orthosis for the patient's comfort. The code for the sock is L-0984.
Here's my problem: For years, in my own practice, I have supplied torso
socks with LSOs and TLSOs, two per orthosis. I notice, however, that recently
Medicare has been disallowing one of them. On a recent claim which we
submitted for reconsideration, the decision came back that the first sock was
covered, but the second was a luxury and therefore not covered.
Obviously we orthotists all know that a second sock is not a luxury. One
is to wear while one is being washed. Would we consider someone with two
pairs of underwear to be extravagant? But that isn't the point. If Medicare
isn't allowing two socks per orthosis, I want to know so I don't steer my
customers (orthotists) wrong.
Can anyone help? What have been your results? Is there any way to ask
Medicare for a ruling on their policy without a specific claim before them?
(I know I need to attend a coding seminar, which I have not done, and I
plan to, but perhaps someone can help me with this question.)
Thanks, in advance. I will post responses, with names (unless instructed
not to).
David J. Hendricks, CPO, FAAOP
<Email Address Redacted>
HOPE, Inc.
brace. Along with it I sell a specially-made TLSO sock to wear under it. I
have been recommending for orthotists to supply two of those socks with each
orthosis for the patient's comfort. The code for the sock is L-0984.
Here's my problem: For years, in my own practice, I have supplied torso
socks with LSOs and TLSOs, two per orthosis. I notice, however, that recently
Medicare has been disallowing one of them. On a recent claim which we
submitted for reconsideration, the decision came back that the first sock was
covered, but the second was a luxury and therefore not covered.
Obviously we orthotists all know that a second sock is not a luxury. One
is to wear while one is being washed. Would we consider someone with two
pairs of underwear to be extravagant? But that isn't the point. If Medicare
isn't allowing two socks per orthosis, I want to know so I don't steer my
customers (orthotists) wrong.
Can anyone help? What have been your results? Is there any way to ask
Medicare for a ruling on their policy without a specific claim before them?
(I know I need to attend a coding seminar, which I have not done, and I
plan to, but perhaps someone can help me with this question.)
Thanks, in advance. I will post responses, with names (unless instructed
not to).
David J. Hendricks, CPO, FAAOP
<Email Address Redacted>
HOPE, Inc.
Citation
“US Billing Question, HCFA payment for TLSO socks,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/213983.
