Billing and Coding Protocols for Functional Orthotics
Implement Orthotics, from Prescription to Payment
Review this video training to best understand how functional orthotics fit into a patient’s treatment plan. This Rapid Tutorial walks providers and team members through the process of understanding why so many DCs choose to stabilize their patient’s feet to affect corrections made in the spine.
The Non-Insurance Reimbursement Process for Orthotics
Billing for Orthotics in Shoes or Sandals
Foot Levelers has a wide selection of shoes and sandals. Sometimes, patients opt for the full shoe rather than just the orthotic insert. However, third-party payers are not obligated to pay for shoes in most cases. Download and review this Fact Sheet to get the full spectrum of properly billing for these items.
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Billing for Orthotics in Shoes or Sandals
Proper Use of Code S1001-Luxury Item, Patient Aware
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