Very often, third-party payers allow for a fee schedule that is lower than the cost of functional orthotics. Participating providers run into difficulty when ordering custom orthotics because the quality is so much higher than the fee schedule allows for. In this case, you may be able to have the patient “opt-in” to the higher cost orthotics, agreeing to cover the overage. This Fact Sheet outlines the process for S1001, and considerations that must be taken into account. Additionally, since January 2022, these costs would also be included on any required Good Faith Estimate in conjunction with the No-Surprises Act.

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Proper Use of Code S1001-Luxury Item, Patient Aware