Healthcare Solutions, the Jurisdiction A and Jurisdiction D Durable Medical Equipment Medicare Administrative Contractor, released a statement about the correct billing for custom-fitted orthotics when no custom fitting is completed with no off-the-shelf equivalent.
“When a prefabricated custom fit orthosis is being provided directly to a beneficiary and no custom fitting is completed at the time of delivery, the corresponding prefabricated off-the-shelf HCPCS [Healthcare Common Procedure Coding System] code must be billed on the claim. When there is not a corresponding prefabricated off-the-shelf HCPCS code for the HCPCS categorized as Custom Fitted Orthotics, miscellaneous codes must be used for billing,” reads the announcement.
