Results of: US L-code request
Tom Masters
Description
Collection
Title:
Results of: US L-code request
Creator:
Tom Masters
Date:
8/16/2011
Text:
In an earlier post of the above subject I said: US Practitioners, Don Joy
recommended L-3675 for their Sully Shoulder Stabilizer does not pay my cost.
We would appreciate suggestions for valid alternate L-code(s). Thanks in
advance.
There was a lot of interest. The following responces covers them all.
___________
The only way to be paid properly is to use the unlisted procedure code for
the orthosis. Then put in a description of the orthosis. When Medicare stop
using this code many insurance companies followed. I suggest you take
payment on delivery and assisted your patient by providing good
documentation.
This is so common with many items. Everything will need a non assignment
form. I forget what medicare calls it when you know your cost will exceed
the patient service you provide.
If your contracted with an insurance company you will have to find a like
product that is cheaper.
Hope you get some better answers. If the product is already dispensed
without any paperwork that spells out a fair reimbursement for you then
caulk it up to a learning experience.
I offer this for double our cost, and then print out an online resource
where patients can buy it for our cost plus shipping. I measure the patient
and tell them what size to order as a courtesy. There's not decent coding
option.
If it is a Medicare patient, you have to check the PDAC to make sure the
item is approved and then you have to use the code it is approved for. You
can always submit as a L3999 and give a description similar to L3675
except..... and then describe the difference and put in an appropriate
price that covers your cost/time. Unfortunately if the item is approved for
a specific code and that code is contracted through their insurance with
your company, you have to accept the cost for it. We are obligated to follow
contracts, that's why it is a contract. Hopefully you make it up elsewhere
with another patient that you get excellent reimbursement on.
I hope this helps.
Use L2999 and send a mfg. invoice with the claim. You can make your own
invoice that includes the product info and charge an amount that will cover
your cost. This seems to work very well for us.
Great to hear what people think. Non covered item at this point, but would
be perfect for the miscellaneous code.
You can have your patient sign an advanced beneficiary notification stating
they will be responsible for overages on the device if there is not a
suitable code.
Talk to carrier and see if price for the code can be adjusted.
There are no other codes available for those. We only provide those as a
cash pay device.
Don't use don joy
_______________
Thank you to all the contributors.
recommended L-3675 for their Sully Shoulder Stabilizer does not pay my cost.
We would appreciate suggestions for valid alternate L-code(s). Thanks in
advance.
There was a lot of interest. The following responces covers them all.
___________
The only way to be paid properly is to use the unlisted procedure code for
the orthosis. Then put in a description of the orthosis. When Medicare stop
using this code many insurance companies followed. I suggest you take
payment on delivery and assisted your patient by providing good
documentation.
This is so common with many items. Everything will need a non assignment
form. I forget what medicare calls it when you know your cost will exceed
the patient service you provide.
If your contracted with an insurance company you will have to find a like
product that is cheaper.
Hope you get some better answers. If the product is already dispensed
without any paperwork that spells out a fair reimbursement for you then
caulk it up to a learning experience.
I offer this for double our cost, and then print out an online resource
where patients can buy it for our cost plus shipping. I measure the patient
and tell them what size to order as a courtesy. There's not decent coding
option.
If it is a Medicare patient, you have to check the PDAC to make sure the
item is approved and then you have to use the code it is approved for. You
can always submit as a L3999 and give a description similar to L3675
except..... and then describe the difference and put in an appropriate
price that covers your cost/time. Unfortunately if the item is approved for
a specific code and that code is contracted through their insurance with
your company, you have to accept the cost for it. We are obligated to follow
contracts, that's why it is a contract. Hopefully you make it up elsewhere
with another patient that you get excellent reimbursement on.
I hope this helps.
Use L2999 and send a mfg. invoice with the claim. You can make your own
invoice that includes the product info and charge an amount that will cover
your cost. This seems to work very well for us.
Great to hear what people think. Non covered item at this point, but would
be perfect for the miscellaneous code.
You can have your patient sign an advanced beneficiary notification stating
they will be responsible for overages on the device if there is not a
suitable code.
Talk to carrier and see if price for the code can be adjusted.
There are no other codes available for those. We only provide those as a
cash pay device.
Don't use don joy
_______________
Thank you to all the contributors.
Citation
Tom Masters, “Results of: US L-code request,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/232881.
