Medicare and minor repairs

Medicare and minor repairs

David Hansford

1/31/2008

I am posting the following replies to my inquiry regarding repairs and
Medicare reimbursement.

 

These are the responses received:

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You will not have problems billing L7520. This is a labor code and only
pays you for time spent doing the repair. If you replaced a minor part,
this should cover you. If you replaced a major part, there should be a code
for the item. I would not bill the L7510 or L5999 you know what that leads
to.

David Falk, LPO

----------------------

 

Medicare only pays up to 80% of any claim presented to them. The remaining
20% is either handled by the patient's secondary insurance or the patient
pays the balance. I hope this helps.

 

Thank you,

 

Michelle Gathren

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I too am having problems. I had to go all the way to an ALJ to get pd on a
myo hand repair. there were numerous problems, most of which, is that there
does not seem to be an approved mark up for parts or repairs (in the case of
an otto bock invoice). It took over a year to get paid any amt.

 I would like to hear your responses, because this is a problem.

 pls post or forward.


Tom Martin, CPO

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 I don't know about Medicare but this has worked for me with some private
insurances. When they request an invoice for the parts they may not require
the actual manufacturers invoice. Create your own invoice on your
letterhead that itemizes the items used and your charges for those items.
Expect the same percentage reduction on the fees charged.
I know this is silly and redundant to the actual billing but who said our
system made any sense?
Ted A. Trower C.P.O., FAAOP

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Try L4205 and L4210 for parts and labor. There are also several new codes
(in the L4200 range) that deal with repairs for AFO's and KAFO's.

 

Barbara Mitchem, DC, LO

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One response simply said- NON-ASSIGNED CLAIMS!

 

There appears to be a problem and I would like to hear how our national
associations would respond. I am not a member of AOPA so I can't turn to
them for help. I am sure that this is a valid issue to raise with CMS
because this discourages cost effective repairs or else I am missing out on
some special process that others are using.

  One person, who did not want their response posted, basically said
replacement of the major component (feet, knees, sockets, liners, hands,
hooks, myo-hands and myo-hooks) is the most efficient way to get paid.
Instead of repair or part replacement, replace the major part completely.

 I'm not so sure that is a valid justification.

Dave Hansford, CPO