Got FAQs?

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By Lisa Lake-Salmon

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 am a new O&P provider, and I am not certain as to what documentation is required to provide a patient with an AFO or KAFO.

A:You must have a signed prescription on file that states the features of the base HCPCS code and all additions that will be billed on a separate line. Please note when billing for either L4396 or L4392 that your prescription must include the patient's diagnosis.

Q: I billed for the first time a breast prosthesis to Medicare and my claim was denied for CO-16. I contacted Medicare and I was told my claim was missing the appropriate modifier. Which modifier do I use?

A: When billing for a breast prosthesis, you must use either the RT (right) or LT (left) modifier.

If the patient had a bilateral mastectomy, you must use both modifiers on one line item and your number of units should be two.   

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,

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.