Wednesday, May 25, 2022

PRAFO and multipodus boot billing for Medicare

Jason Auyer

Hello list,

I was wondering if anyone has any suggestions for billing Medicare Part B
for a multipodus boot or PRAFO to specifically offload plantar diabetic
ulcers. From my understanding medicare will only pay for L4396 for either
PF contractures, or plantar fascitis, even though the descriptor for the
code falls in line for pressure reduction (from how I read it). Therefore,
the only code that can be used for Medicare for these situations is A9283,
which is a non-covered code. Therefore, any Medicare patient would have to
sign an ABN and end up paying out of pocket for these items.

Is there anything that I am missing or any other suggestions for how to
properly bill Medicare for this item.

Thank you,

Jason Auyer, LCP, LCO
Licensed Certified Prosthetist, Licensed Certified Orthotist
Atlanta Prosthetics and Orthotics
1100 Sherwood Park Drive
Suite 220
Gainesville, GA 30501
ph: (770) 287-2395
fax: (770) 287-2398


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