Got FAQs? - February 2019

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By Lisa Lake

Count on Got FAQs? to help answer your toughest billing questions. This month's column addresses changes to HCPCS codes for 2019 and changes to billing for bilateral products. Also, it answers questions about billing for devices for patients in a skilled nursing facility (SNF) or for devices that cannot be delivered.

 

Q: I have read your column for the last ten years and find your information extremely helpful. I look forward to reading your column at the beginning of each year to find out which HCPCS codes have been added or deleted. Would you provide any new codes or modifiers I need to be aware of? Also, I have received a request for a prosthesis for a patient in an SNF. Is this covered by Medicare?

 

A: According to the 2019 HCPCS Code Annual Update, the following O&P codes have changed:

 

A-5514: For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each.

 

L-8701: Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated.

 

L-8702: Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated. This information can be found at https://bit.ly/2FhdKna.

 

Also, effective for claims with dates of service on or after March 1, suppliers billing for bilateral products that are delivered on the same day must bill each item on separate claim lines using the RT and LT modifiers and one unit of service on each claim line, or the claim will be rejected as incorrect coding. This information can be found at https://bit.ly/2Ce4oVl.

 

In regard to billing a prosthetic device to a patient in a SNF, the following codes are not subject to consolidated billing for Medicare beneficiaries in an SNF Part A covered stay. They should be submitted to the Part B MAC or DME MAC, as appropriate, for payment consideration: L-5050, L-5060, L-5100, L-5105, L-5150, L-5160, L-5200, L5210, L-5220, L-5230, L-5250, L-5270, L-5280, L-5301, L-5311, L-5312, L-5321, L-5331, L-5341, and L-5500. For the complete list of codes that are not subject to SNF consolidated billing for a SNF Part A covered stay, visit https://go.cms.gov/2REftsh  and click on Part A Physician Services.

 

Q: I recently started working for a provider in Texas. We made a custom brace for a Medicare beneficiary, but he passed away before picking it up. How do I bill for the device?

 

A: As stated in the Medicare Supplier Manual, Chapter 5, page 3, Artificial Limbs, Braces, and Other Custom-Made Items Ordered but Not Furnished (https://www.cgsmedicare.com/jc/pubs/pdf/chpt5.pdf): "If a custom-made item was ordered but not furnished to a beneficiary because the individual died or because the order was canceled by the beneficiary or because the beneficiary's condition changed and the item was no longer reasonable and necessary or appropriate, payment can be made either on an assigned or unassigned claim basis, based on your expenses." If this happens, the date of service is either the date the beneficiary died, the date you learned of the cancellation of the item, or the date you learned that the item was no longer reasonable and necessary or appropriate for the beneficiary's condition. The allowed amount is based on the services furnished and materials used, up to the date you learned of the beneficiary's death or of the cancellation of the order or that the item was no longer reasonable and necessary or appropriate. The DME MAC determines the services performed and the allowable amount appropriate in the situation, taking into account any salvage value of the device.

 

Lisa Lake is an independent medical consultant with over 24 years of experience in the O&P industry, increasing providers' revenue by product recommendation, product and billing knowledge, and contract access assistance. She is a nationally recognized speaker on billing reimbursement and government compliancy. While every attempt has been made to ensure accuracy, The O&P EDGE is not responsible for errors. Lake can be contacted at llakeusa@gmail.com.