Until now, suppliers billing for bilateral DME devices including therapeutic shoes for patients with diabetes, diabetic inserts, custom AFOs or custom foot orthoses, have been able to submit electronic claims by indicating the total quantity and using the RTLT modifier on a single line OR by using RT on one line and LT on another, noting half the quantity on each.
Beginning March 1, 2019, such claims MUST be submitted using two separate lines, using the RT and LT modifier on each. Units of service (UOS) should be “1″ on each line for shoes and for AFOs; it should be up to “3″ on each line, for prefabricated or custom diabetic inserts. Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT and / or LT modifier or with RTLT on a single claim line, will be rejected as incorrect coding.
Suppliers who have been submitting codes for bilateral devices using one line are advised to start billing on two separate lines NOW and not wait until March 1.
As always, each claim line should also include the modifier KX to indicate that all required compliance documentation is on file. When billing L3000 for custom foot orthotic devices, the GY modifier should be used to indicate that the item is statutorily excluded and cause the claim to deny.
For a link to the Medicare carrier website and Policy Articles, see:
Question: Does the 2% payment reduction under sequestration apply to the payment rates reflected in Medicare fee-for-service fee schedules or does it only apply to the final payment amounts?
Time and time again I am asked the same four questions about AFOs: