Anthem Blue Cross Best Billing Practices Regarding L3000 - L3030 Custom Foot Orthotics

This article aims to shed light on a few best practices with respect to billing for certain services. It is best practice for providers to work cooperatively with insurers and health plans to resolve billing issues so as to encourage the continued exceptional treatment of patients. We appreciate that sometimes there are billing issues that lack sufficient clarity and may lead to disputes and provide this overview to address common billing issues.

1. Foot Orthotic Unbundling

In a Publication by the American Orthotic and Prosthetic Association (AOPA) and supported by both American Podiatric Medical Association (APMA) and the Pedorthic Footcare Association (PFA) the following components are INCLUDED in the descriptions of each device L3000, L3010, L3020 and L3030. Each code description includes the following passage: HCPCS code(s) L3000, L3010, L3020 and L3030 “includes additions such as postings, padded top covers, soft tissue supplements, balance padding and lesion or structure accommodations. Other additions may be required as well.” https://www.aopanet.org/wp-content/ uploads/2016/06/L-Code-Definition-Clarification-051316.pdf. Thus, some carriers, including Anthem, consider it inappropriate to bill for ADD-ON components in a la carte fashion—including but not limited to L2275, L2280, and L2820—in conjunction with custom foot orthotics (L3000 – L3030).

2. Foot Orthotic Casting (S0395)

The only appropriate billing code to use to represent the impression “casting” service (e.g., plaster slipper cast, foam impression or digital scan) of a patient who will receive custom foot orthotics fabricated by an outside lab (someone other than the one providing the casting service) is HCPCS code S0395. It is advisable to check with individual health plans and insurers to determine their specific DME or Reimbursement Policy regarding this casting service (S0395). Anthem considers it inappropriate to bill for Orthopedic casting service codes—including but not limited to CPT code 29515 (application of short leg splint [calf to foot]) and 29799 (Unlisted procedure, casting or strapping) in association with custom foot orthotics as they represent orthopedic casting services and are not specific to the custom orthotic services.

3. Supply Codes for Custom Foot Orthotics

Custom foot orthotic casting (S0395) includes any supplies and/or transport services used to perform this included service. These are not eligible for independent reimbursement. Supply and Transport services include, but are not limited to, 99002, 99070, A4580, A4590, Q4037, Q4038 and Q4050. Insurers and health plans want physicians, facilities and other health care professionals to submit claims accurately and, to that end, often provide resources to help ensure accurate claim submission. Note also that industry practices are constantly changing, and insurers and health plans review and revise their policies periodically. Thus, it is essential that Providers have a process in place to stay abreast of changes to insurers’ billing guidelines, as they will likely be contractually obligated to follow the current guidelines even if they fail to review them.

CPMA’s House of Delegates Selects Leadership

AND SETS GOALS FOR THE COMING YEAR

After an absence of nearly three years due to the COVID-19 Pandemic, the 2022 California Podiatric Medical Association’s House of Delegates (HOD) once again convened at the Disneyland Hotel and Convention Center in Anaheim, CA. Dozens of doctor delegates and alternates representing CPMA’s eighteen local component societies (from Shasta Region in the North to San Diego in the South) received in-depth briefings from national, state, and local leaders in medicine, management, and education on legislative affairs; the Podiatric Medical Board of California (formally the Board of Podiatric Medicine (BPM)); important healthcare policy issues impacting podiatric physicians, their patients, practices, and specialty; regulatory matters; podiatric medical education, and legal issues affecting the practice medicine and management.

ELECTIONS

Duties of Delegates of the 2022 CPMA House of Delegates include selecting the Association’s leadership for the coming year. The 2022-2023 California Podiatric Medical Association’s elected Board of Directors, as voted by the 2022 CPMA House of Delegates, are as follows: Holly Spohn-Gross, DPM (Lake Isabella), was elevated to President. Diane Koshimune, DPM, FACFAS (San Jose), was elected President-Elect. And, Phong Le, DPM, FACFAS (Sacramento), was elected Secretary-Treasurer. Heather McGuire, DPM (Ventura), was reelected to a second two-year Director-at-Large term. Elected to a one-year Director-at-Large term in 2021, Douglas Taylor, DPM (Walnut Creek), was elected to a new two-year term. Finally, Ebonie Vincent, DPM, MBMS, DABPM (Orange), was elected to the CPMA Board of Directors as a Director-at-Lage for a two-year term. The 2022 House was also charged with selecting the delegation representing California at the 2023 American Podiatric Medical Association (APMA) House of Delegates (HOD) next spring in Washington, DC. Michael Cornelison, DPM FACFAS (Cupertino) was re-elected as a four-year delegate. Those elected as one-year delegates to the 2023 APMA House of Delegates are Adam Howard, DPM (Cupertino); Jon Hultman, DPM, MBA, CVA (Los Angeles); Holly Spohn-Gross, DPM (Lake Isabella), and Stephen Wan, DPM (Los Angeles). The three Alternates selected to attend APMA’s 2023 HOD are Diane Koshimune, DPM, FACFAS (San Jose); Ronald D. Jensen, DPM (Modesto); and Heather McGuire, DPM (Ventura). The 2022 CPMA House of Delegates was also the backdrop for the presentation of Awards:

CPMA AWARDS

The 2022 CPMA President’s Award went to California Medical Association (CMA) Immediate Past President Peter Bretan, MD.CPMA’s Immediate Past President Adam Howard, DPM, was the recipient of the Executive Director’s Award. Faridi G. Sherieff, DPM, President, San Luis Obispo/Santa Barbara Podiatric Medical Society was named CPMA Local Society President of the Year. Ara Kelekian, DPM, President of the Los Angeles County Podiatric Medical Association, received CPMA’s Step-Up Award for LACPMA’s generous donation to the Clark-Foster-Kaplan Golf Tournament (which raises funds for APMAPAC) and for the society’s assistance in CPMA’s 2021 Membership Campaign. Ebonie Vincent, DPM, star of TLC’s hit show “My Feet Are Killing Me,” was the recipient of CPMA’s 2022 Rising Star Award. Finally, CPMA Past President Franklin Kase, DPM, FACFAS received the Association’s first-ever Legend Award in recognition of his numerous, invaluable contributions to the California Podiatric Medical Association, its members, their patients, and the specialty of podiatric medicine.

CALPPAC AWARDS

The Los Angeles County Podiatric Medical Association received the 2022 CalPPAC Awards for Society with Largest Total Contribution and for Society with the Largest Percentage of Members Contributing. The Santa Clara Valley Podiatric Medical Association received the Honorable Mention Award.