E codes for rental orthoses RESPONSES
Randy McFarland
Description
Collection
Title:
E codes for rental orthoses RESPONSES
Creator:
Randy McFarland
Date:
7/9/2012
Text:
ORIGINAL POST
We had a request for a dynamic orthosis. Several manufacturers tell us
that the codes for non-custom dynamic splints are E codes which are
rentals. To date, our facility has not dealt with rentals. As an O&P
provider, have you dealt with the rental E codes? What services/followup
is implied to be included with E codes?
Thanks, Randy McFarland, CPO
RESPONSES
I find it easier to just order dynamic joints of some type and make a custom
orthoses rather than deal with rentals. Usually we communicate with the
doctor or therapist on this and we have had no issues. In addition, some
insurances like Medicaid do not pay for a non custom brace but will pay for
a custom orthosis. So we have to go custom to get the patient what he or
she needs. What is the diagnosis and what area of the body is being
addressed? You can also check with Ultraflex. I don't use their products
but I think they have L-codes on them, if you are willing to use L2999 on
the dynamic joints.
Use caution in entering the world of rentals as you are then required to
have accreditation that covers DME rather than just ancillary assistive
devices.
Check with the organization that grants your facility accreditation to be
sure.
You may also be required to hold an additional state license as a DME
dealer. There are many additional regulations you need to comply with.
The issues you need to address are not huge, but you need to be aware of
them going forward to avoid problems.
Just looked at PDAC for E1810 for reference, looks like they've put all the
dynamic bracing as rental items, didn't know this. We do not provide rental
product which has to be monitored and retrieved when the patient no longer
needs it, billed monthly to the insurance, then the product must be
sanitized and pads replaced before it can be put on the shelf for the next
patient. I see some of the product on this list does not have removable
pads yuck! We don't provide used equipment, we are not going to start
sanitizing used equipment, we only provide new equipment. We have always
billed the closest suitable Lcode(s). In future will have to find options
for Medicare and Medicaid patients.
Most E codes are provided by DME providers. You should make sure you are
contracted for those codes/services before providing service under you
Medicare or ancillary provider contracts. There are separate requirements
and guidelines for DME providers vs O & P.
Stay away from them.... Headache.....some of the jaz splints have lcodes
You need to be able to bill for the E code, but E 1810 nu. Is for new sale.
Some insurances will only pay for a rental too.
Please keep us in mind for any of your custom or OTS static progressive
splint needs for joint contractures, www.orthoinnovations.com
I spoke with aopa last week about this. They said the company has to be set
up as a rental dme company (oxygen wheelchairs ect) in order to bill e
codes. I have found Medicaid and third party payers paying for kids using
the proper lcodes but they are non covered by Medicare. Ultra flex doesn't
recommend ecodes because those products are are on custom devices and ate
for purchase only
Ultraflex does not recommend billing e-codes for any of its dynamic braces
as these codes are used for durable medical equipment (DME) capped rental
type items. Since Ultraflex bracing is never intended for reuse for multiple
patients (as the DME type items are) it is inappropriate to use a rental
(e) code since the implication of any rental arrangement is that the item
can be furnished over and over again to different parties. Ultraflex
recommends L codes for all of its bracing since: L codes are set aside for
use for orthotic and prosthetic items; Ultraflex bracing meets standard
definitions of an orthosis such as the one set forth by CMS and its Durable
Medical Equipment Medicare Administrative Contractors (DME MACs); and L
codes allow for a purchase arrangement between the orthotist and the patient
which is appropriate since Ultraflex braces are manufactured for single
patient use.
This being said, Medicare has published Local Coverage Determinations
through its DME MACs which state that lower extremity braces that are
dynamic in nature be billed with e-codes. However, other insurance providers
(both public and private) do not necessarily follow the same policy.
Ultraflex has been aggressively working with CMS to demonstrate the
distinction between L coded orthotics and rental DME items and has made
significant headway toward achieving this realization. It is important to be
aware of that while Medicare maintains this policy, other insurance
providers have their own policies many of which do not mandate the use of
e-codes for dynamic orthoses. Since Ultraflex braces meet the standard
definition of orthoses, we believe L codes are the appropriate ones for
billing them. Please feel free to respond or call me at the number below if
you would like to discuss this further.
Bill Harding Ultraflex Systems 610.906.1410 (phone) Ext. 100 610.906.1420
(fax)
We had a request for a dynamic orthosis. Several manufacturers tell us
that the codes for non-custom dynamic splints are E codes which are
rentals. To date, our facility has not dealt with rentals. As an O&P
provider, have you dealt with the rental E codes? What services/followup
is implied to be included with E codes?
Thanks, Randy McFarland, CPO
RESPONSES
I find it easier to just order dynamic joints of some type and make a custom
orthoses rather than deal with rentals. Usually we communicate with the
doctor or therapist on this and we have had no issues. In addition, some
insurances like Medicaid do not pay for a non custom brace but will pay for
a custom orthosis. So we have to go custom to get the patient what he or
she needs. What is the diagnosis and what area of the body is being
addressed? You can also check with Ultraflex. I don't use their products
but I think they have L-codes on them, if you are willing to use L2999 on
the dynamic joints.
Use caution in entering the world of rentals as you are then required to
have accreditation that covers DME rather than just ancillary assistive
devices.
Check with the organization that grants your facility accreditation to be
sure.
You may also be required to hold an additional state license as a DME
dealer. There are many additional regulations you need to comply with.
The issues you need to address are not huge, but you need to be aware of
them going forward to avoid problems.
Just looked at PDAC for E1810 for reference, looks like they've put all the
dynamic bracing as rental items, didn't know this. We do not provide rental
product which has to be monitored and retrieved when the patient no longer
needs it, billed monthly to the insurance, then the product must be
sanitized and pads replaced before it can be put on the shelf for the next
patient. I see some of the product on this list does not have removable
pads yuck! We don't provide used equipment, we are not going to start
sanitizing used equipment, we only provide new equipment. We have always
billed the closest suitable Lcode(s). In future will have to find options
for Medicare and Medicaid patients.
Most E codes are provided by DME providers. You should make sure you are
contracted for those codes/services before providing service under you
Medicare or ancillary provider contracts. There are separate requirements
and guidelines for DME providers vs O & P.
Stay away from them.... Headache.....some of the jaz splints have lcodes
You need to be able to bill for the E code, but E 1810 nu. Is for new sale.
Some insurances will only pay for a rental too.
Please keep us in mind for any of your custom or OTS static progressive
splint needs for joint contractures, www.orthoinnovations.com
I spoke with aopa last week about this. They said the company has to be set
up as a rental dme company (oxygen wheelchairs ect) in order to bill e
codes. I have found Medicaid and third party payers paying for kids using
the proper lcodes but they are non covered by Medicare. Ultra flex doesn't
recommend ecodes because those products are are on custom devices and ate
for purchase only
Ultraflex does not recommend billing e-codes for any of its dynamic braces
as these codes are used for durable medical equipment (DME) capped rental
type items. Since Ultraflex bracing is never intended for reuse for multiple
patients (as the DME type items are) it is inappropriate to use a rental
(e) code since the implication of any rental arrangement is that the item
can be furnished over and over again to different parties. Ultraflex
recommends L codes for all of its bracing since: L codes are set aside for
use for orthotic and prosthetic items; Ultraflex bracing meets standard
definitions of an orthosis such as the one set forth by CMS and its Durable
Medical Equipment Medicare Administrative Contractors (DME MACs); and L
codes allow for a purchase arrangement between the orthotist and the patient
which is appropriate since Ultraflex braces are manufactured for single
patient use.
This being said, Medicare has published Local Coverage Determinations
through its DME MACs which state that lower extremity braces that are
dynamic in nature be billed with e-codes. However, other insurance providers
(both public and private) do not necessarily follow the same policy.
Ultraflex has been aggressively working with CMS to demonstrate the
distinction between L coded orthotics and rental DME items and has made
significant headway toward achieving this realization. It is important to be
aware of that while Medicare maintains this policy, other insurance
providers have their own policies many of which do not mandate the use of
e-codes for dynamic orthoses. Since Ultraflex braces meet the standard
definition of orthoses, we believe L codes are the appropriate ones for
billing them. Please feel free to respond or call me at the number below if
you would like to discuss this further.
Bill Harding Ultraflex Systems 610.906.1410 (phone) Ext. 100 610.906.1420
(fax)
Citation
Randy McFarland, “E codes for rental orthoses RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/233830.
