Got FAQs?

Home > Articles > Got FAQs?
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: 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 him know that he 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.

Q: I am a provider of spinal orthoses. Have there been any deletions of HCPCS Codes for 2004?

A: Effective April 1, 2004, the following codes have been deleted for spinal orthotics: L-0476, L-0478, L-0500, L-0510, L-0520, L-0530, L-0540, L-0550, L-0560, L-0561, L-0565, L-0610, L-0620, and L-0960. These codes will be considered invalid by Medicare for claims submission on or after April 1, 2004.

Q: As an O&P provider, I receive many requests to deliver items to a patient while he or she is in the hospital and find I have a hard time being paid for these services by Medicare. Please advise me how to properly bill Medicare for these services.

A: According to DMEPOS, you may deliver items to a patient during an inpatient stay at a hospital--as long as the delivery date is within two days prior to discharge and the item is needed for fitting and training purposes. When billing Medicare, your date of service should be the patient's discharge date instead of date of delivery. Your place of service should either be "11" (office) or "12" (home). You should have all the proper documentation in the patient file to support this information.

We invite readers to ask any questions you have regarding billing, collections, or any other information. To send your questions or for more information, contact:lisa@westernmediallc.com.

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 VP of Acc-Q Data, Inc.