This the last in the series of
“Mini-Gems”, taken from the extensive DME and IOD writings by the late Rich
Levin, DPM. When presenting this information in a lecture, Dr. Levin
included an example of a claim form. A copy of that sample form is
available at the FootZine web site, and can be accessed from the link at
the bottom of this section. Thanks again to Dr. Ornstein for
making these materials available for us to share with you.
Orthotics and Medicare: Many podiatrists
work under the assumption that Medicare does not reimburse for orthotic devices.
Well, this is not true. Medicare, through DMERC, will pay for functional
full-length orthotics, with amputee fill, for patients who have had an
amputation of their foot or any part of their foot. The reason for the
amputation can be due to diabetes, PVD, infection or trauma.
You must be enrolled in Medicare and have obtained a Durable Medical Equipment
Supplier number to bill code L5000 to DMERC. They only cover the orthotic
for the foot with the amputation. I always make the contra lateral foot a
functional orthotic as well, but do not bill for it, as I would not want the
patient walking about with one orthotic device for all the obvious reasons.
The diagnosis code to use when billing L5000 are V49.71 -Amputation of Great
Toe, V49.72 - Amputation of lesser digit and V49.73 - Amputation Foot/partial
foot. It is important to understand that code L5000 is not to be billed
annually for those patients in the Diabetic Shoe Demonstration Program. As
with all DME devices, other than wound care products and Diabetic shoes and
inserts, they are expected to have a useful life span of five years. If
you are dealing with a diabetic patient with an amputation on one foot, who
qualifies for shoes and inserts, you can bill for the shoes (2 units) inserts (3
units) and amputation fill orthotic (1 unit). (see sample hcfa form)
The following year you can obtain new shoes and inserts for the patient, but not
a new amputation fill orthotic. If you have a patient with bilateral
amputations, you can bill 2 units of L5000 and your fee will not be reduced for
the second device. When you do make an L5000 amputee fill orthotic for a
patient it is best to send their shoe with your cast, to your lab of choice, to
insure proper fit and fabrication of the amputee fill orthotic device.
Dr. Ornstein adds the following notes on Dr. Levin's article:
The sample claim shown is for bilateral devices. Generally, the left
and the right should be on two separate lines on the claim so that the insurance
company does not read it as one unit. Also, with DME items, there is not
the 50% reduction for multiple codes that is applied to surgery.
They pay 100% of their usual and customary allowance for each item.
Here is the link to the sample form. Depending on your connection, this
large file may take a minute or more to load:
More to come................
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