Monday, June 17, 2024

KAFO Partial payment


I recently provided Bi KAFO’s which were Fillauer SPL2’s. I billed Medicare and only received payment for L2005, which as you know just covers my cost for the braces. All other codes were denied with a CO-97 which states the benefit for this service is included in the payment for another service that has already been adjudicated. We did a same or similar for L2005- L2830 and nothing came up so I don’t understand how this was included in prior payments of any other service. Has anyone had this happen and appealed and won payment for the add on codes?

Jorge Gonzalez Jr
CPO Metropolitan Brace & Limb


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