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Aug 13

Written by: Larry Huppin, DPM
8/13/2012 1:12 PM

I have received a number of questions lately on how to bill Medicare for foot orthoses. First, realize that Medicare does not pay for functional foot orthotics under any circumstance. This doesn’t mean that they won’t pay accidently if you bill it. It means that you should not bill it and if you do they will ask for their money back and maybe audit you. So don’t try to get Medicare to pay for FFOs.

You may have to bill Medicare for FFOs, however, in order to receive a denial so that a secondary insurance can be billed. If you do this you must include a modifier that essentially says “Hey Medicare, I’m billing for these orthotics, but I don’t want you to pay for them, just give me a denial.

To do this, you must use the GY modifier. So, you would bill Medicare as follows:

L3000-GY-LT
L3000-GY-RT.

The "GY" modifier is the payment modifier, and indicates the HCPCS code is statutorily NOT covered by Medicare. This modifier will cause Medicare to issue a "PR" (patient responsibility) denial on the EOB that results in either a cross-over to the patient's secondary insurance or, if there is no other plan, notes it is the patient's responsibility to pay.

ProLab takes a scientific approach with our orthoses by integrating evidence-based medicine into orthotic therapy. Our team of Medical Consultants regularly evaluates the medical literature pertaining to orthotic therapy and biomechanics. ProLab clients are encouraged to contact a medical consultant whenever they have questions about an orthotic prescription.

For an easy way to stay up-to-date on evidence-based orthotic therapy, subscribe to our free E-Journal. Your will receive a monthly email synopsis of the research that impacts your practice.       

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