Re: Medicare question on billing humeral fracture brace, Region C-responses

Re: Medicare question on billing humeral fracture brace, Region C-responses

Paula Pivko

8/31/2012

Hi everyone, I must have done mass e-mail deletions off my Android because now I can't find responses to my original question about billing a humeral fracture brace and Medicare wanting additional information. However, generally the responses were: do not use KX modifiers for upper extremity. I can't see why I wouldn't use KX for upper when I'm using it for lower extremity orthoses so if someone knows for a fact KX is not to be used, please let me know. I'm sure no matter the orthosis Medicare would like to ensure proper documentation is on the claim; I know spinal orthoses have the CG code. Make sure the date of injury is on the claim. We are adding that, it wasn't there before. L3995 can't be used with a pre-fab humeral brace code. L3995 is the fracture sock code if I'm not mistaken. Submit copy of prescription, clinical notes and physicians notes with the claim, along with manufacturers invoice. By the way the question was asked if Kx was to be used with prosthetic codes? I didn't think so but if someone can answer yes or no I'd appreciate it. Thank you for your responses. I will try to let you know the outcome.Paula Martinek, LPOPort Saint Lucie, Fl