How To Master Billing For Orthotics

Anthony Poggio, DPM

Dispensing Orthotics: Determining What Is And Is Not Covered
When determining orthotic therapy, one decision is whether to recommend OTC versus custom-made devices. Patients have often already tried such devices before they come to your practice and you should document this in the chart. Over-the-counter orthotics that one dispenses in the office are generally not covered by insurance carriers and these devices usually involve direct cash payment from the patient.
Many patients have health savings accounts (or “cafeteria plans”). In these situations, your staff generates a bill for the patient so he or she can get reimbursed from one of these accounts. Patients will still be paying you cash at the time of delivery of the items.
The dispensing of orthotics is generally included in the cost of the orthotic.There are codes for orthotic dispensing but these are for orthotists and not for physicians who provide professional services. Check with each insurance carrier regarding its guidelines for orthotic follow-up. Consider the office visit of a patient who complains that an edge of the orthotic is causing pain. In this case, the patient needs a simple orthotic adjustment.
Consider the office visit of another patient who you are evaluating for plantar fasciitis to see if the orthotic is making a positive impact or if you need to alter your treatment course. There is no E/M component in the orthotic adjustment scenario whereas there is an E/M component when it comes to following up on the patient’s treatment progress.
One error that office staff and clinicians commonly make is billing L3030 orthotic devices with an associated casting fee.The description of a L3030 device is a device that one molds directly to the patient’s foot. Obtaining a plaster mold/cast would not be appropriate for this code series.
The next determination is the use of L3000 versus L3020. In regard to an orthotic that has a posted heel with a deep heel cup, it is best to bill this as an L3000 device. The L3020 does not have a heel post and is described as a longitudinal arch support in the American Orthotic and Prosthetic Association manual.
It is important for you and your staff to familiarize yourselves with these descriptions of the various orthotic types in order to bill the appropriate device and ensure that your chart note backs up this code selection. Also be aware that each carrier may have its own policies as to what orthotic codes it may allow. Again, make sure your staff is aware of these policies.



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?

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