Medicare’s Pricing, Data Analysis and Coding (PDAC) has revised it’s original review of the Moore Balance Brace and determined the HCPCS codes to use for billing to be:
- L1940 – ankle foot orthosis, molded to patient, plastic
- L2820 – addition to lower extremity orthoss, soft interface for molded plastic, below knee section
- L2330 – addition to lower extremity orthosis, lacer molded to patient model, for custom fabricated orthoses only.
The 2012 maximum allowable fees for these codes are:
- L1940 $571.10
- L2820 $100.28
- L2330 $453.44
Medicare fees vary by state so go to www.dmepdac.com to determine the specific allowable amounts for your patients.
The Moore Balance Brace is commonly prescribed bilaterally to address risk factors contributory to increased risk of falling. Frequently determined diagnoses that might benefit from the stability afforded by the MBB include:
- Muscle weakness (728.87)
- Ataxia, muscular incoordination (781.3)
- Gait abnormality/ staggering, ataxic (781.2)
- Osteoarthritis, localized primary ankle & foot (715.17)
- Arthropathy, unspecified, ankle and foot (716.97)
- Pain in joint, ankle, foot (719.47)
- Instability of joint, ankle & foot (718.87)
- Dropfoot (736.79)
- Hemiplegia (438.20)
Click Here for information on how you can incorporate a fall prevention program in your practice, or register for a free informational webinar!
For additional information about the Moore Balance Brace and fall prevention please contact SafeStep at 866.712.STEP (7837) or email email@example.com.
PDAC Certification Letter
A patient needs to have two different sized shoes–one 13, and one 14. I will be charged extra for this and wonder how I’m to pass this charge on. Can I bill the patient?
Additional cost incurred by fitting (I assume Medicare) patient with two different size shoes cannot be passed onto patient (assuming that you accept assignment). If you do not accept Medicare assignment you can charge patient whatever you want such that increased cost is borne by patient. Less significant differences in foot size (especially in width) can sometime be accommodated with the same size shoe by removing spacers from the larger foot and adding spacers to the smaller foot. domain search availability Alternative, if size is significant enough is to cast patient for custom molded shoes.
Josh White, DPM, CPed
In 2011, many podiatrists were audited by Medicare and had to refund money because rules had changed and many were not aware of the documentation required to fit diabetic shoes.
As one famous retailer once said, “An educated consumer is our best customer”. In that spirit I have acquired one of the world’s largest collections of audit letters relating to the Medicare therapeutic shoe program. Examples are displayed in the “Library” section on the SafeStep website, accessible only after logging in.
When podiatrists have failed shoe audits, the vast majority of times it has been for :
- Failure to demonstrate that the primary care physician has documented a qualifying foot condition and has had an in-person visit with the patient during which diabetes management is addressed within 6 months prior to the patient receiving shoes.
Even when podiatrists have figured out what they need to do to be complaint, the effort required to fill out the necessary forms and the time required to repeatedly fax these forms to the primary care physician and to be assured that the patient had a visit in the proceeding 6 months is so onerous that it might hardly seem worth the effort.
Guess what? There is a convenient way to assure Medicare compliance when fitting shoes and it’s called, “WorryFree DME”.
Here are the steps:
- Identify patients with Medicare and diabetes.
- Evaluate patients and determine qualifying conditions for therapeutic shoes.
- Select appropriate footwear.
- Fill out SafeStep information collection form.
- Enter required information into SafeStep website.
You are done! SafeStep takes over!
- SafeStep creates the Statement of Certifying Physician for Therapeutic Shoes.
- SafeStep creates the documentation required to be in the patient’s file of the primary care physician.
- SafeStep assures that patient was seen by primary care physician not more than 6 months prior to being fit with shoes.
- SafeStep faxes the forms, as though from the podiatrist for up to 3 weeks to get required signatures and dates.
Without any more work on your part:
- SafeStep sends you the signed and dated documents.
- SafeStep ships you the shoes.
Don’t let fear of Medicare audits nor the effort required to be compliant stop you from providing important care to your patients and creating revenue for your practice.
Use WorryFree DME to fit your patients conveniently and compliantly.
To learn more, go to SafeStep.net and register for a free 45 minute webinar on how to get started.