There are additional new code for both pneumatic and non-pneumatic cam
walker (“Walking Boot to use the PDAC terminology). The old ones, L4360 and
L4386 respectively, are still active, billable codes.
The ADDED code for Pneumatic Walking Boot is L4361 and here’s the PDAC long
description:
Long Description: WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT
JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED, OFF-THE-SHELF.
The New York State Medicare allowance for this is $253.29.
The ADDED code for Non- Pneumatic Walking Boot is L4387 and here’s the PDAC
long description:
Long Description: WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS,
WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED, OFF- THE-SHELF
The New York State Medicare allowance for this is $145.93.
Now look at the PDAC description for the older, still active established
codes for L4360 and L4386:
Long Description: WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT
JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN
TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC
PATIENT BY AN INDIVIDUAL WITH EXPERTISE.
L4386 uses the same description except for the “non-pneumatic” change.
Both new codes have the same reimbursement as their older analogous codes.
SO WHAT’S THE DIFFERENCE? The requirement that the item HAS BEEN TRIMMED,
BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT
BY AN INDIVIDUAL WITH EXPERTISE HAS BEEN ELIMINATED.
The reimbursement is the same!!!!
Herb Shalant, C.P.O.
White Plains, NY
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