Hal Ornstein DPM, FACFAS

President, American Academy of Podiatric Practice Management
Partner, S.O.S. Healthcare Management Solutions LLC

Lynn Homisak, PRT
Trustee, American Academy of Podiatric Practice Management
Past President, ASPMA
Partner, S.O.S. Healthcare Management Solutions LLC

  Gem #57

"Orthotic Pearls"

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................

Gem Archives


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