Orthotics Coverage FAQs

Q:

I billed a carrier for orthotics, and when I got the check, it didn’t cover the price I paid for the orthotics—I’m essentially paying patients to wear them! I’m in-network with the carrier; do I have any options?
A: If you know the covered fee schedule is lower than the amount you paid for the orthotics, or the allowed amount is unreasonable regarding meeting your overall costs, you do have options. Depending on your contract with the carrier, try using the S1001 code billing concept outlined in the Foot Levelers Billing Guide.

Q:

How much do I charge for the scan on the Foot Levelers 3D BodyView Scanner or Kiosk?
A: There is usually no additional fee for the evaluation when you are simply scanning the feet—the cost of the scan is included in the costs for the orthotics when they are ordered. If you are performing a separately identifiable Evaluation and Management (E/M) service with documentation that follows EM Guidelines, you can bill for the E/M service if appropriate. KMC University has a library full of E/M coding training and information available if you’re interested in maximizing your profits by documenting these services.

Q:

How can I charge for my time spent fitting orthotics when they come from the manufacturer?
A: There is no exact rule for this; however, it may be appropriate to bill 97760 for the visit when you dispense the orthotics. The rules and coding guidelines set by the carrier you’re billing apply. Here is a description of the 97760 code:

97760 Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes.

This code can be billed the day the functional orthotics are dispensed to the patient but can only be used for “custom fabricated” supports. The code includes the fitting for the functional orthotics; training in the use, care, and wear time of the functional orthotics, and brief instructions for exercises to practice while the functional orthotics are in place. Direct one-on-one contact by the provider is required, and it is a timed code so include the time in your documentation. All the services you provided that day should be outlined in your daily note.