Q: I am an O&P provider who has recently been receiving referrals for diabetic shoes and inserts. I was wondering if a patient needs to be insulin-dependent in order for Medicare to pay for diabetic shoes and inserts.
A: As long as a patient is a diabetic,
it does not matter whether they are insulin-dependent or not.
Medicare will consider it to be medically necessary as long as the
patient’s diagnosis is one of the following: 250.00 to 250.93.
Remember to always take your diabetic ICD-9 to the fifth digit and
to use your diabetic modifier.
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 them know that they 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.
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, contact: [email protected] .
Acc-Q-Data provides billing, collections and practice management
software serving the O&P industry nationwide for over a
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.