OA knee orthosis L codes RESPONSES
Randy McFarland
Description
Collection
Title:
OA knee orthosis L codes RESPONSES
Creator:
Randy McFarland
Date:
6/10/2008
Text:
Original Question:
I was told by a manufacturer that they only recommend L1846 for a custom
Osteo Arthritis knee orthosis with two joints with no add-on procedures.
It this what Medicare is requiring now?
Randy McFarland, CPO
Fullerton, CA
Responses: (separated by a blank line)
Unfortunately, yes
I believe that is correct
Randy, as far as I know the additional codes are still ok to add on. I
have no awareness of L1846 being a stand alone code.
You can call Medicare though, and they will tell you your answers, if
your unable to find it on their website.
There is a new Medicare Policy for knee orthoses for Jurisdiction C.
I'm sure it will be the same for all of the US.
I think after July 1st, yes, but I can verify that in the office
Monday. We just received our new KO policy Wed.
The description of 1846 covers everything except interface materials and
condylar pads.
In the past, I have added 2820, 2830 and 2810 x 2. I have also added
code 2770 x 2 and 2780 non-corrosive x 4. Non so far have been denied
and feel all are solid codes to add to the custom orthosis. I did have
to justify to a non Medicare third party at one time. After the proper
explanation, the claim was paid. Hope this helps.
I have used codes that a mgf. printed and have not been denied.
no, but beginning july, it'll pretty much be it and you'll have to have
every custom molded one pre-approved by mcare. aopa sent a warning on
this to every member about 1.5 mths ago.
looks like as of july, only dme companies will be able to pull the knee
braces due to volume discounts they get. will be virtually impossible to
compete against at what we pay for customs.
There is a list somewhere of the deleted codes, which includes several
of the add-on codes for custom knee braces.
With all these reductions in codes and deeper discounts from
insurance companies, especially Anthem which is the big one here where I
live, it has become a real losing battle to provide any knee braces
here. There is NO way to make any money doing these braces, and so I
don't provide that service here in my office anymore. It's not a matter
of not making enough money to make it worth my time, but the actual
brace costs more than the allowed amounts from several insurance
companies.
For example, the last knee brace I did here was for a patient with
Anthem (an employee at local university, which contracts with Anthem to
administer their benefits, they are self-funded), and what I got from
Anthem...their allowed amount for a custom Knee Orthosis, with all the
additional codes and everything, was in the ball park of a whopping $600
for the brace. The COST of this brace (a Townsend brace) was around
$1000, and there was shipping (about $100 for the round trip), and then
2 rolls of fiberglass ($20 ??) and then a couple hours of my time to
cast, and then box it up, go and ship it, and all the paperwork and
wasting time on the phone to fight with them just to get paid at all,
being on hold for 30 minutes one time, and even longer another time,
only to get to talk to some person that is being paid to NOT pay
claims....which is another story in iteself.... So, I SPENT about $1200
and a few hours of my life only to get back around $600 for all that.
I will NOT do that anymore and I explain that to every patient that
comes here, or calls here, for a brace (which seems to be quite a few,
especially from the University with such a huge athletic department).
And, on top of that, the insurance for the students is a different
policy, I think with Aetna, but they have NO benefits for O&P at all.
I tell students that call here, or come and talk to me in person, that
they have no benefits for that, and what the cost of the braces runs,
and they lose interest in getting one really fast.
So I hope this answers some questions. I don't know exactly where
the list is of the deleted codes and new codes is right now, but I do
remember seeing some of the Knee Brace additional codes getting deleted
this go around, and also the last update before that.
I was told by a manufacturer that they only recommend L1846 for a custom
Osteo Arthritis knee orthosis with two joints with no add-on procedures.
It this what Medicare is requiring now?
Randy McFarland, CPO
Fullerton, CA
Responses: (separated by a blank line)
Unfortunately, yes
I believe that is correct
Randy, as far as I know the additional codes are still ok to add on. I
have no awareness of L1846 being a stand alone code.
You can call Medicare though, and they will tell you your answers, if
your unable to find it on their website.
There is a new Medicare Policy for knee orthoses for Jurisdiction C.
I'm sure it will be the same for all of the US.
I think after July 1st, yes, but I can verify that in the office
Monday. We just received our new KO policy Wed.
The description of 1846 covers everything except interface materials and
condylar pads.
In the past, I have added 2820, 2830 and 2810 x 2. I have also added
code 2770 x 2 and 2780 non-corrosive x 4. Non so far have been denied
and feel all are solid codes to add to the custom orthosis. I did have
to justify to a non Medicare third party at one time. After the proper
explanation, the claim was paid. Hope this helps.
I have used codes that a mgf. printed and have not been denied.
no, but beginning july, it'll pretty much be it and you'll have to have
every custom molded one pre-approved by mcare. aopa sent a warning on
this to every member about 1.5 mths ago.
looks like as of july, only dme companies will be able to pull the knee
braces due to volume discounts they get. will be virtually impossible to
compete against at what we pay for customs.
There is a list somewhere of the deleted codes, which includes several
of the add-on codes for custom knee braces.
With all these reductions in codes and deeper discounts from
insurance companies, especially Anthem which is the big one here where I
live, it has become a real losing battle to provide any knee braces
here. There is NO way to make any money doing these braces, and so I
don't provide that service here in my office anymore. It's not a matter
of not making enough money to make it worth my time, but the actual
brace costs more than the allowed amounts from several insurance
companies.
For example, the last knee brace I did here was for a patient with
Anthem (an employee at local university, which contracts with Anthem to
administer their benefits, they are self-funded), and what I got from
Anthem...their allowed amount for a custom Knee Orthosis, with all the
additional codes and everything, was in the ball park of a whopping $600
for the brace. The COST of this brace (a Townsend brace) was around
$1000, and there was shipping (about $100 for the round trip), and then
2 rolls of fiberglass ($20 ??) and then a couple hours of my time to
cast, and then box it up, go and ship it, and all the paperwork and
wasting time on the phone to fight with them just to get paid at all,
being on hold for 30 minutes one time, and even longer another time,
only to get to talk to some person that is being paid to NOT pay
claims....which is another story in iteself.... So, I SPENT about $1200
and a few hours of my life only to get back around $600 for all that.
I will NOT do that anymore and I explain that to every patient that
comes here, or calls here, for a brace (which seems to be quite a few,
especially from the University with such a huge athletic department).
And, on top of that, the insurance for the students is a different
policy, I think with Aetna, but they have NO benefits for O&P at all.
I tell students that call here, or come and talk to me in person, that
they have no benefits for that, and what the cost of the braces runs,
and they lose interest in getting one really fast.
So I hope this answers some questions. I don't know exactly where
the list is of the deleted codes and new codes is right now, but I do
remember seeing some of the Knee Brace additional codes getting deleted
this go around, and also the last update before that.
Citation
Randy McFarland, “OA knee orthosis L codes RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/229427.
