Oct 17

Written by: Larry Huppin, DPM
10/17/2011 1:39 PM

The September 20, 2011 issue of Podiatry Management magazine has an entire section devoted to orthotic therapy. There are several articles I think would be beneficial for ProLab clients to read. One of those is Paul Kesselman’s update to orthotic billing for 2011. He notes that there are four important issues that have occurred in orthotic therapy billing in the last year.

• The first is that some third-party payers are no longer using HCPCS coding for foot orthotics and instead have developed their own codes.
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• He notes that some insurance companies have developed specific requirements for heel cup depth in order to reimburse for orthotics.
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• He also notes that the reimbursement formulas used by third-party payers have become more difficult to understand and follow.
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• Finally, he notes that there are several associations that represent podiatrists and other orthotic providers that have been developing their own interpretation of the L-Codes devoted to orthotic therapy.

Dr. Kesselman’s article then went on to focus on a review of the common L-Codes used for orthotic therapy.

Dr. Kesselman made special note that orthotics made from computerized “library systems” are a predetermined orthotic shape and do not, under current guidelines, fit the definition of a custom orthosis. He also stated that there recently has been an increase in the number of orthotic labs that are advertising custom orthotics for around $40. He noted that it appears that most of these devices are not truly custom, but rather are manufactured based on several measurements taken from the negative cast of the foot. He goes on to say that a podiatrist who is using this type of device should understand that it would not be appropriate to use one of the standard L-Codes for third-party reimbursement.

He then gave a list of some items that anybody should lookout for when evaluating the orthotic lab. These include:

• Whether the lab is fair and honest regarding pricing.
• Whether they offer a “loss leader” basic orthotic and then charge high prices for any changes and high prices for shipping.
• He noted it is very important to look at the level of experience and expertise of the technicians and consultants at each laboratory.
• He stated they should look closely at the level of service being offered and whether your lab had experienced people offering biomechanical consultation.

In summary he noted that many of the codes currently used for orthotics are confusing and that they were developed in the 1960s for non-podiatric providers. He noted that new definitions for coding for foot orthotics are necessary to more accurately match the devices that are currently available.

I highly recommend that every orthotic practitioner read this article. Dr. Paul Kesselman is a great resource to the profession and an expert in billing for all kinds of durable medical equipment.

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