Thursday, May 26, 2022

split codes and private insurance

Porter, Joseph E.

I am curious how people are handling OTS split codes when it comes to billing private payers such as BCBS, Aetna, UHC, etc. Our experience has been that sometimes they don’t allow the code or often require authorization. For example we were told by one insurance company that L4361 requires auth. We pointed out that it is the same device as L4360 just without adjustments and that doesn’t require auth but were told that L4361 was not on their list of immediate need codes. Are people billing the split OTS codes to private payers or are you continuing to use the traditional codes? Maybe I’m wrong but I can’t see undertaking the administrative burden to get some of these device authorized when the same device with a different code doesn’t require auth. Please advise.

Thanks in advance!


Joseph E. Porter, CO, PTA
Orthotic Department Supervisor
Orthopaedic & Sports Medicine Center
Phone: 410-267-5578 Fax: 410-268-0986

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