Evidently, based upon the “out of the office” replies that I received, many
folks have already left for the holidays. Anyway, there were two responses
to the original request (between the asteriks) and they are:
Reply 1.
All S-Codes codes are used the same as L-Codes. The S simply demarks codes
that are not covered by medicare but may be billed to other third party
insurances.
Reply 2.
In researching cranial remolding codes a few years back, I came across a
CMS document titled HCPCS Temporary Coding decisions for 2003 that said:
“Types of temporary HCPCS codes: The S codes are used by the BCBSA
and the AHIP to report drugs, services and supplies for which there are no
national codes but for which codes are needed by the private sector to
implement policies, programs, or claims processing. They are for the purpose
of meeting the particular needs of the private sector. These codes are also
used by the Medicaid program, but they are not payable by Medicare.”
The S1040 codes was listed for that year, but I have never seen the
rest of the codes you found. We have had inconsistent results in having
S1040 acknowledged and / or paid for by the privates.
So, my next question is, “is anyone using any of the S Codes below or CPT
codes, such as: 97504 – Orthotic Training or 97520 – Prosthetic Training for
Medicaid or other 3rd party payors with any success?” I’m still not sure
why S Codes were developed by CMS inasmuch that there are several L Codes
that are non-covered by Medicare, but are still listed as L Codes and are
often paid by agencies, such as Medicaid or other private carriers. This
seems confusing to me. There must be another reason. In particular, I
would like to know if anyone is having success with S0395 for Medicaid or
the private sector. Thanks again for your replies.
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Following is a list of codes that I have stumbled onto. Does anyone knows
why these codes exist and for whom? These codes were found in the 2005
Medicare listing from CMS. Thanks for your help.
Wil Haines, CPO, LPO
S0395 00100 3 IMPRESSION CASTING OF A FOOT PERFORMED BY A PRACTITIONER OTHER
THAN THE MANUFACTURER OF THE ORTHOTIC
S1001 00100 3 DELUXE ITEM, PATIENT AWARE (LIST IN ADDITION TO CODE FOR BASIC
ITEM)
S1002 00100 3 CUSTOMIZED ITEM (LIST IN ADDITION TO CODE FOR BASIC ITEM)
S1040 00100 3 CRANIAL REMOLDING ORTHOSIS, RIGID, WITH SOFT INTERFACE
MATERIAL, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT(S)
S8420 00100 3 GRADIENT PRESSURE AID (SLEEVE AND GLOVE COMBINATION), CUSTOM
MADE
S8421 00100 3 GRADIENT PRESSURE AID (SLEEVE AND GLOVE COMBINATION), READY
MADE
S8422 00100 3 GRADIENT PRESSURE AID (SLEEVE), CUSTOM MADE, MEDIUM WEIGHT
S8423 00100 3 GRADIENT PRESSURE AID (SLEEVE), CUSTOM MADE, HEAVY WEIGHT
S8424 00100 3 GRADIENT PRESSURE AID (SLEEVE), READY MADE
S8425 00100 3 GRADIENT PRESSURE AID (GLOVE), CUSTOM MADE, MEDIUM WEIGHT
S8426 00100 3 GRADIENT PRESSURE AID (GLOVE), CUSTOM MADE, HEAVY WEIGHT
S8427 00100 3 GRADIENT PRESSURE AID (GLOVE), READY MADE
S8428 00100 3 GRADIENT PRESSURE AID (GAUNTLET), READY MADE
S8429 00100 3 GRADIENT PRESSURE EXTERIOR WRAP
S8433 00100 3 SKIN SUPPORT FOR BREAST PROSTHESIS, EACH
S8450 00100 3 SPLINT, PREFABRICATED, DIGIT (SPECIFY DIGIT BY USE OF
MODIFIER)
S8451 00100 3 SPLINT, PREFABRICATED, WRIST OR ANKLE
S8452 00100 3 SPLINT, PREFABRICATED, ELBOW
S8470 00100 3 POSITIONING DEVICE, STANDER, FOR USE BY PATIENT WHO IS UNABLE
TO STAND INDEPENDENTLY (E.G. CEREBRAL PALSY PATIENT)
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