missing modifier ??

missing modifier ??

Michael P Madden

1/22/2003

I had a rather unusual situation arise, and am looking for any
clarification/assistance I can find. Will post responses.

I fit a patient with bilateral double upright AFO's attached to custom
molded shoes. The patient is non-diabetic, with RA
deformities/deterioration of the foot and ankle complex, with lower
extremity weakness (ie. mild to moderate drop foot/ M-L instabilities).
She was informed prior to the provision of the CMS's that Medicare
probably would not pay for them, as she is not a diabetic.

My understanding is that Medicare only covers custom shoes if the patient
has IDDM, with related complications. I do know that their is coverage/a
code for oxfords attached to an orthosis, but I am not aware of a
code/coverage for CMS's attached to an orthosis. The only possibility I
am aware of is to bill it as an L ...999, for which results are very
unsure...and in the past has not yielded a fair and reasonable
reimbursement

This patient was seen in the MD's office by another practitioner (who's
office is in the same building) for an unrelated issue, and discussed
our billing with the patient. The patient stopped by my office with a
note from this practitioner stating that There should be a modifier to
the custom molded shoes to indicate that they are attached to the braces.
Custom shoes are covered when attached to braces. You should reapply.

Is anyone aware of such a modifier? Anyone have any experience with a
similar situation? Any help would be appreciated.

Thanks

Mike Madden, BOC (O&P), C.Ped

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