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Medicare Covering Orthotics?

Question:
I heard through the grapevine that Medicare has started to cover orthotics.

Is this true or rumor?

If they are covering does anyone know what diagnosis, and whether the coverage is for L3020?

Answer:
Foot orthotics (L3xxxx) are not covered, and likely will never be for the vast majority of Medicare patients.

The only circumstance where foot orthotics (L3xxxx) are covered under Medicare is when a patient has a leg brace attached to the shoe and that shoe (billed and covered by Medicare) is an integral part of that brace. Only the supplier who provides the shoe and the brace can provide and bill for the foot orthotic.

Not meeting that requirement, yet still billing L3xxxx with a “KX” modifier indicating that you DID meet the very strict requirements may be construed as potentially fraudulent billing.