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Billing Orthotics to DMerc

Posted: Tue Dec 04, 2018 8:06 am
by mbpros
We are having a problem billing orthotics (L3000) to DMerc. We are billing using L3000 with a NU modifier and an RT (or LT) modifier, such as L3000-NU-RT or L3000-NU-LT. We do have a referring provider also listed but all claims are rejecting from DMerc, saying invalid line information HCPCS.

Any ideas? We also tried billing without the NU modifier.

Any guidance to billing orthotics to DMerc?

Steve

Re: Billing Orthotics to DMerc

Posted: Tue Dec 04, 2018 10:15 am
by Gavin Walker
So HCPC = L3000, modifier 1 = NU, and modifier 2 = RT. Possibly the procedure is not valid for the date of service that was entered.

Re: Billing Orthotics to DMerc

Posted: Tue Dec 04, 2018 10:32 am
by dkennelly
As a rule, Medicare, and therefore, DMERC do not cover orthotics unless they are part of a brace/shoe. If the secondary will cover it, it needs to be submitted with GY modifier to generate a rejection to submit to the secondary.

Re: Billing Orthotics to DMerc

Posted: Mon Dec 10, 2018 6:52 pm
by mbpros
Found out that a KX modifier must be added to any L codes (like L3000) when billing DMerc; that's the reason the claims denied.

Thanks,
Steve