It does appear that I have been billing incorrectly. However; I called
Medicare again this morning and they once again said foot orthotics are
covered. And that they didn’t have specifics as to what would qualify a
patient for them. After looking through Medicare’s Web page
(www.palmettogba.com), there are several references that back up what
everyone has told me, and the fact that they are not covered unless provided
with diabetic shoes or it is an integral part of an orthosis. This latter
part is probably why team services keeps telling me the wrong answer.
Medicare really should change the wording. Is a foot orthotic not an
orthosis? So that would make them an “integral part of an Orthosis”. This is
reaching I know, but from the replies received, I was not the only one who
was confused. The coverage criteria for these codes is poorly worded by
Medicare (as usual). I appreciate the responses and as many of you said, I
have committed fraud (un-knowingly of course). After reviewing my records it
looks like about a dozen patients I have billed for foot orthotics in the
past 2 years that were not part of an orthosis or for diabetes. And several
of them were other insurances. The reason for me posting the message to
start with was to make certain I was billing correctly, as I believe most of
us are honest and want to do things by the book. Thanks to all
Jeremy Sprouse CPO
