Medicare Billing question for LSO

Medicare Billing question for LSO

Paula Pivko

5/27/2011

I have a billing question. I am in C region if it matters. I was looking at a website, the Centers for Medicare/Medicaid services. <URL Redacted>. In the article on TLSOs/LSOs they mentioned using a CG modifier for L0628 and L0450 if the garment is not made of elastic material. The CG modifier must be added to code L0450, L0454, L0625, or L0628 only if it is one made primarily of nonelastic material (e.g., canvas, cotton or nylon) or having a rigid posterior panel. (Refer to the Coding Guidelines section of the Policy Article for instructions on the use of code A4466 for elastic spinal garments.) Has anyone else had to do this? I ask because we got a denial because of incorrect or missing modifer. The item in question was L0628, a lace up corset. Would we use CG in addition to the KX modifer? Thank you in advance for your responses. Sincerely,



Paula Martinek, LPO
 
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