Q: I am an O&P provider who has recently been receiving referrals for diabetic shoes and inserts. I was wondering if a patient needs to be insulin-dependent in order for Medicare to pay for diabetic shoes and inserts.
A: As long as a patient is a diabetic, it does not matter whether they are insulin-dependent or not. Medicare will consider it to be medically necessary as long as the patient's diagnosis is one of the following: 250.00 to 250.93. Remember to always take your diabetic ICD-9 to the fifth digit and to use your diabetic modifier.
Q:If I have a patient who requires a shoe attached to a brace, how do I bill Medicare for a pair of shoes, if the patient only has one leg brace?
A: If you give the patient a pair of shoes, Medicare will only reimburse you for the one shoe that is attached to the integral leg brace. If you give the patient an ABN form letting them know that they would be required to pay for the other shoe, you may then bill Medicare for the shoe that is attached to the brace with the KX modifier along with either the RT or LT modifier. The other shoe should be billed on a separate line with a GA modifier, along with your RT or LT modifier. Medicare will deny the line item with the shoe not attached to the brace, but this will allow you to bill the patient for the one shoe. You can only bill the patient for the one shoe if you have an ABN form signed on file and you billed with the GA modifier.
We invite readers to ask any questions you have regarding billing, collections, or any other related information. To send your questions or for more information, contact: firstname.lastname@example.org .
Acc-Q-Data provides billing, collections and practice management software serving the O&P industry nationwide for over a decade.
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.