Got FAQs?

Content provided by The O&P EDGE
Current Issue - Free Subscription - Free eNewsletter - Advertise

The future of your practice depends on knowledgeable billing and collection information. Understanding the full aspect of billing guidelines and procedures will effectively increase your reimbursement. This informative column will help providers and their staff with a better understanding of billing procedures and reimbursement strategies.

Q:  I recently received a CO-16 denial from Medicare for L-1885. I was told the code was no longer valid. Do you know the correct code that replaced this and which modifiers I should use in order to be reimbursed?

A: HCPCS code L-1885 was changed to code E-1810. This code is now in the capped rental category and needs to be billed with the following modifiers: RR KH for the first month of the rental, RR KI for months two and three, and RR KJ for rental months four through 13. After the 13th month, the brace then will be considered purchased, and Medicare will no longer pay for the rental even if the patient still has the brace.

Q:  I am a pedorthist at a facility in Maryland. What is the current billing code for L-3030? Do you know where I can print out the new codes for orthopedic footwear, inserts, and modifications?

A: According to DMERC Region A, L-3030 still is a valid code. You can go to to find all the recent codes and fee schedules. You also can sign up on Medicare's website to receive all the Medicare updates and changes as they are released.

Q:  We billed Medicare for a prosthetic leg and received a denial on L-5685. According to DMERC, our claim needs additional information in order for it to be paid. I am not sure if you have covered this in the past but would greatly appreciate it if you could tell me what information Medicare is looking for.

A: When billing code L-5685 to Medicare, the claim must include a narrative description of the item, the manufacturer, and the model name or number (if applicable). By supplying this information to Medicare, your claim should now be paid.

We invite readers to ask questions regarding billing, collections, or related subjects. For more information, contact Acc-Q-Data provides billing, collections, and practice management software and has served the O&P industry nationwide for more than a decade.

Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.

Bookmark and Share