L3240 & L3250

L3240 & L3250

Boland Prosthetic & Orthotic Center

2/14/2002

I have a question regarding L3240 and L3250 Custom Molded shoes. This patient is a 2 year old child with a disorder that causes her limbs to be 3 times the size of a normal child. Obesity is not the case but she requires custom compression hose and custom molded shoes. Her primary insurance does not cover shoes and her secondary insurance is Medicaid. I have researched the Medicaid manual and in section 805.2 there is some documentation supporting the prior approval and payment of these type of devices. Now it was my understanding that Medicare and Medicaid do not cover custom molded shoes unless you are a diabetic?? My questions are:

A: are there any facilities who have succeeded at payment from Medicaid for custom molded shoes?

B: if so - which code was successful (section 805.2 lists L3240 as the code to be prior approved, but in the reimbursement section of the manual it does not list L3240 but only L3250) Back to the noncovered issue I was under the impression that those codes ommitted in the Medicaid manual were infact noncovered items?

All comments would be greatly appreciated. I will be more than happy to post all comments and or our experiences after this is all done with.

Thanks in advance


Stephanie