Billing Orthotics to DMerc

Technical problems with Medisoft.
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mbpros
Posts: 253
Joined: Fri Mar 11, 2011 6:59 pm

Billing Orthotics to DMerc

Post by mbpros » Tue Dec 04, 2018 8:06 am

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
Steven Zats
Medical Billing Professionals

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Gavin Walker
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Re: Billing Orthotics to DMerc

Post by Gavin Walker » Tue Dec 04, 2018 10:15 am

So HCPC = L3000, modifier 1 = NU, and modifier 2 = RT. Possibly the procedure is not valid for the date of service that was entered.
Gavin Walker
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dkennelly
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Joined: Tue Oct 21, 2008 5:18 pm

Re: Billing Orthotics to DMerc

Post by dkennelly » Tue Dec 04, 2018 10:32 am

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.

mbpros
Posts: 253
Joined: Fri Mar 11, 2011 6:59 pm

Re: Billing Orthotics to DMerc

Post by mbpros » Mon Dec 10, 2018 6:52 pm

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
Steven Zats
Medical Billing Professionals

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