A Guide to Accurate Orthotics Billing Numerous Medicare beneficiaries in the US are dependent on durable medical equipment supplies considering their health condition. These DMEs along with orthotics and prosthetics supplies are quite expensive, hence DME and orthotics billing require special attention to maintain the financial health of your practice. DMEPOS are necessary to improve the quality of life and maintain independence of the patients. However, the regulatory intricacies in orthotics and DME billing make it difficult for your staff to maintain accuracy within the overall process. Thus, you develop a chance of potential revenue loss within the process.
Steps in DME and Orthotics Billing Medicare payment for most DMEPOS is based on fee schedule amount. Orthotics billing comes under Medicare Part B which covers 80% of the approved costs of custom-made or pre-made orthotics items. The steps in precise billing for DME and orthotics are as follows The entire workflow starts with a prescription as applicable, before it is eligible for coverage A typed CMS 1500 claim form is used for billing Appropriate HCPCS level II codes along with applicable modifiers (including, but not limited to NU, RR) are incorporated within the bill Bill maintenance and repair modifier codes Use miscellaneous codes as applicable You must provide a complete description of the item With the initial claim consider submitting the factory invoice if required Make sure there is medical necessity form with physician’s approval Appropriate Codes for Orthotics Billing Under section 1861(s)(9) of the Social Security Act orthotics are defined. These orthotics require minimal self-adjustment for appropriate use and do not require any specialized attention for bending, molding, trimming or customizing to fit the individual needs. CPT codes for orthotics are used for orthotic evaluation, fabrication, selection and training.