Billing Instruction for Prefabricated Braces Without an OTS code

Over the years there have been many changes to the HCPCS coding for orthoses. With the most recent overall CMS established two L code sets; Prefabricated and Custom Fabricated. A prefabricated orthosis may be considered an off the shelf (OTS) or a custom fitted device that may be trimmed, bent, molded (with or without heat),…

Read More

Reimbursement: Understand New Flexibility

Q.  Can I apply the same new guidance for PAP masks to other accessories? A. In February 2024, the DME MACs published a Dear Physician Letter (DPL) clarifying Medicare’s stance of masks for PAP and RAD devices. The DPL specifically addressed the PAP and RAD device masks, but does the same flexibility apply to other…

Read More

Reimbursement: Document Qualifying Test Result

Q. What do I need to document in the medical record to meet current oxygen policy requirements? A. The current oxygen policy requires the practitioner to order and evaluate the results of a qualifying blood gas study performed at the time of need. I believe this requirement stems from the national coverage determination (NCD) but Medicare…

Read More