<<--CODE WHAT YOU PROVIDE & PROVIDE WHAT YOU CODE-->>
T
his is an analysis, explanation, and clarification tool put together by the PFA Coding
Committee. This document is designed to give
practical and fair advice to today's practitioners
dispensing foot and ankle DMEPOS (Durable
Medical Equipment, Prosthetics, Orthotics, and
Supplies) devices.
The document is designed to expound on the
most common Pedorthic devices and to provide
coding guidelines to be used by practitioners. There
are also sample FAQs in which a question was
developed in a question and answer format to guide
you to the answer of many common questions.
Just because there is a HCPCS code assigned to
the specific devices or modifications being provided
it does not necessarily mean that there is reimbursement for such items or services by Medicare
or third party payers. Generally, in this series of
codes, the only devices or services which will be
covered by Medicare and third party payers are in
instances when the devices are attached to a brace
attached to a shoe.
Medicare and third party payers often do cover
Ankle Foot Orthoses (AFO's) that are permanently
attached to a shoe and their associated modifications. This would include transfer of an orthoses
from one shoe to another.
In the section on L3000 through L3649, the
series of HCPCS codes there covers footwear and
footwear modifications. This includes ladies orthopedic shoes not attached to a brace, men's orthopedic shoes not attached to a brace, orthopedic shoes
attached to a brace, other orthopedic shoes and
32
Pedorthic Footcare Association www.pedorthics.org
specialty orthopedic shoes and shoe modifications.
It explains the L3000 series HCPCS codes by providing the code and it's description, the Pedorthic
Coding Committee's (PCC) description and the
PCC's explanation of each code within this series.
Through the utilization of these HCPCS codes in
the L3000 series you are describing what devices/
services you are providing and creating uniform
best billing practices for Medicare, third party payers and the patient.
Pictures of the footwear modifications are
included in this section of the manual to give a better understanding of the description and explanation of what is being provided. Included within the
L3000 series of HCPCS codes there is a complete
series of HCPCS codes dedicated to pediatric footwear, footwear modifications and bracing (Dennis
Browne Splints). There are areas of specificity
relating to infants, junior and child starting with
the L3140 HCPCS code and continuing to L3214
and L3640. Custom and off-the-shelf foot orthoses are also included within the L3000 through
L3060 HCPCS codes. Other important codes
include “addition to” codes like the L2755, partial
foot codes L5000, L5010 and L5999. Custom shoe
codes involve the use of the L3230, L3250, L3251,
L3252, and L3253 HCPCS codes and include the
description, PCC's description and explanation
of each. This section ends with the repair codes
L4205 and L4210. These repair codes cannot be
used together.
Moving into the diabetic codes the A5500
through the A5513, this section is designed to give