Orthotics & Prosthetics Billing
Orthotics and prosthetics products are specialized devices designed to support or replace a part of the body that has been injured, lost, or otherwise impaired. These devices are custom-made for each individual patient and can range from simple braces and supports to advanced prosthetic limbs and orthotic shoe inserts. Here are some common examples of orthotics and prosthetics products:
Orthotics:
• Ankle-foot orthosis (AFO)
• Knee-ankle-foot orthosis (KAFO)
• Spinal orthosis (TLSO, LSO)
• Wrist splints
• Custom-made shoe inserts
Prosthetics:
• Below-knee (transtibial) prosthetic limb
• Above-knee (transfemoral) prosthetic limb
• Arm prosthetic (including hands and fingers)
• Prosthetic eye
• Breast prosthetic
Orthotics and prosthetics products are designed to improve mobility, reduce pain, and enhance quality of life for individuals with a wide range of medical conditions, including amputations, spinal cord injuries, cerebral palsy, arthritis, and sports injuries, among others. These products are typically prescribed by a healthcare provider and custom-made by a specialized orthotist or prosthetist, who works closely with the patient to ensure a proper fit and function.
Orthotics Prosthetics Codes: What You Need to Know
Orthotics and prosthetics codes are a standardized set of codes used to describe the products and services provided by healthcare providers and billed to insurance companies and other payers. These codes are part of the Healthcare Common Procedure Coding System (HCPCS) and are used in conjunction with the Current Procedural Terminology (CPT) codes.
Here are some common orthotics and prosthetics codes:
Orthotics Codes:
• L1900: Knee-ankle-foot orthosis, plastic or other material, custom-fabricated
• L0625: Lumbar-sacral orthosis, sagittal-coronal control, rigid, custom-fabricated
• L4396: Addition to lower extremity, molded inner boot, below knee section, for use with L-Code L4360 only
• L3000: Foot, insert, removable
Prosthetics Codes:
• L5500: Below-knee prosthesis, molded socket, shin, ankle, and foot (SACH) foot or equal, with toes or equal
• L5635: Above-knee prosthesis, molded socket, suspension sleeve, knee-shin system, and ankle-foot system
• L6935: Hand prosthesis, external powered, for partial hand
• L8030: Breast prosthesis, mastectomy form
It's important to note that the specific codes used may vary depending on the type of device or service provided and the specific payer requirements. Healthcare providers and billing staff must be familiar with the appropriate codes for the products and services provided to ensure accurate billing and timely reimbursement.
In addition to the HCPCS and CPT codes, there are also diagnosis codes used to indicate the medical condition or reason for the orthotics or prosthetics device or service. These diagnosis codes are part of the International Classification of Diseases (ICD) codes and must be included on the claim to support medical necessity for the device or service.
Orthotics Prosthetics Billing and Coding Services by OneMed Billing
OneMed Billing is a medical billing company that provides specialized orthotics and prosthetics billing and coding services to healthcare providers. Our team of billing experts has extensive experience in the complex world of orthotics and prosthetics billing and can help healthcare providers navigate the complex coding and reimbursement requirements to ensure accurate billing and timely reimbursement.
Here are some of the orthotics and prosthetics billing and coding services we provide:
• Claims submission: We submit claims to insurance companies and other payers on behalf of healthcare providers, using the appropriate codes and documentation to ensure accurate and timely reimbursement.
• Coding and documentation review: We review the coding and documentation provided by healthcare providers to ensure compliance with payer requirements and to identify any potential issues or errors that could impact reimbursement.
• Appeals and denials management: We work with insurance companies and other payers to resolve appeals and denials related to orthotics and prosthetics claims, ensuring that healthcare providers receive the full reimbursement they are entitled to.
• Eligibility and benefits verification: We verify patient eligibility and benefits coverage for orthotics and prosthetics products and services, ensuring that healthcare providers have the information they need to make informed treatment decisions.
• Customized reporting and analytics: We provide customized reporting and analytics to help healthcare providers track their orthotics and prosthetics billing and reimbursement, identify trends and opportunities for improvement, and make informed business decisions.
At OneMed Billing, we understand the unique challenges of orthotics and prosthetics billing and coding, and we are committed to helping healthcare providers optimize their reimbursement and streamline their billing processes. Contact us today to learn more about our orthotics and prosthetics billing and coding services.