You Know There is Coverage…Now What?

In the earlier module, you learned how to ensure that specific coverage is available, with all the details, for the specific functional orthotics your practice prescribes. Just because a code is covered in the Medical Review Policy (MRP), it doesn’t mean that code describes the functional orthotics with which you are working. The same goes for the ICD-10 diagnosis codes that describe the condition…is it truly a covered diagnosis? This module walks you through all the specific details of coding, modifiers, and billing best practices when prescribing and ordering functional orthotics.

In this module, you will learn

    • Which HCPCS codes describe which type of orthotics and which ones to use for Foot Levelers’ functional orthotics
    • How to position proper modifiers when billing to ensure that the pair of functional orthotics is carefully considered for payment
    • About a list of diagnoses that are often covered by third-party payers for orthotics prescription
    • Why it’s necessary to carefully review unusual billing situations like Personal Injury or Medicare
    • When to request preauthorization, if necessary, or appeal denials for medical necessity, with template letters provided