How To Master Billing For Orthotics

Anthony Poggio, DPM

Orthotics are an integral part of podiatric practice. They provide viable treatment options for many conditions that we treat. However, there are also associated hard costs with orthotics that can be a financial detriment to the practice if the office cannot collect fees in a timely fashion.
Obviously, your staff should be very aware of coverage criteria for the principal insurance companies that your office commonly deals with when it comes to payment for any service rendered in the office. This will save a lot of time in determining whether orthotics may be a covered benefit for the patient. In regard to lesser known insurance companies, it is wise for office staff to contact them in order to determine eligibility and coverage criteria.
Collecting payment for dispensed orthotics seems to be a sticking point for many offices. Custom orthotics are not inexpensive so affordability becomes an issue. Being upfront with the patient in regard to your fees will put all parties on the same page. This candor allows patients the opportunity to decide if they wish to proceed with obtaining orthotics if the insurance company does not pay for them.
Each office should devise a form that states the cost of the orthotics and associated charges such as casting, orthotic adjustments, etc. Your office should also devise a policy as to what is included in the orthotic fee especially when it comes to patients who are paying cash.
If the insurance carrier does not cover orthotics, many of the services we commonly perform in conjunction with orthotics may not be covered as well. For example, Medicare does not pay for foot orthotics (unless they are associated in a diabetic shoe or with the shoe that is attached to a brace). Medicare will also not pay for range of motion and muscle testing if the testing is related to orthotic fabrication, casting, dispensing and adjustments to the orthotics.

Addressing Informed Consent And Patient Expectations
With any type of service we provide, we need to obtain informed consent.We do not proceed with a surgery without explaining certain risks and benefits. If you cannot meet the patient’s expectations for the surgery, then obviously the patient will be disappointed. Give similar consideration to orthotic devices.Although orthotics can make patients better, they cannot always offer the ideal therapeutic solution. Patients will continue to have high arch or low arch feet, and may accordingly be subject to strain and stress with increased activities. Patients need to be aware that the intent of the orthotics is to improve the function of the foot but the DPM can give no guarantees that the patient will be pain-free.
I use the analogy of a pair of eyeglasses in the office. Orthotics do not alter the foot but they simply make it work better.There are no guarantees that glasses will give the patient 20/20 vision or that orthotics can allow the patient pain-free activity levels. Unlike a pair of glasses, which you can pretty much tell immediately if they work, orthotics will not offer instantaneous improvements but will offer benefits over the course of weeks and months.
Also discuss shoe gear with patients to better determine the proper type of orthotic to prescribe. Patients may be upset if they find that the orthotics fit a very limited number of shoes. The more patients are aware of how orthotics work, the more compliance and satisfaction you will see in these patients.
Have patients sign a payment agreement. This is helpful in documenting that they understand their responsibilities and realize the service may not be covered by their insurance carrier. Also be upfront with the patient when insurance coverage by the carrier is unclear. Most carriers, even if they render an authorization, will still have a disclaimer.The patient’s policy must be active at the time of service and the services must be medically necessary.



Great Article. We have been using the L3030 code across the board as our doctor says its what we need to do. We bill the initial E/M code along with the L3030. When the patient returns to pick up the orthotics, we don't charge. I know we are loosing money; what is a better description of L3030 -Why is a plaster/cast mold not L3030? What material is for L3030?

Add new comment