Custom Orthotic Reimbursement

Are you having trouble getting paid by the insurance company for custom orthotics?

First and foremost, it needs to be established whether or not the physician participates with the insurance plan of the patient. If the answer is yes, then the insurance company needs to be contacted and it needs to be determined if orthotics are covered and reimbursable for this patient. The HCPCS Level II code for the orthotics (ie. L3000, L3020) needs to be provided along with the diagnosis(es) of the patient in order to demonstrate the medical necessity for the orthotics. 

My advice in these situations is to immediately request to speak with a supervisor. Obtain the supervisor’s name and ID number (if available). If the answer is an affirmative one, obtain the fact that the orthotics are a covered service for this patient in writing. Another possibility is to submit a letter of medical necessity for the orthotics to the insurance company. I would follow up to make sure that I receive a hard copy response. If the orthotics are indeed a covered service for this patient, I do not believe that it would be appropriate to collect a deposit for the orthotics. After all, if the issue was whether or not a hallux valgus correction was covered, assuming that the answer was an affirmative one, would you really take a deposit from the patient prior to performing the surgery? 

On the other hand, if the orthotics are NOT covered by the patient’s insurance company, I would so obtain a deposit. I would make sure that it would be at least 1/2 of the patient’s cost for the orthotics. In fact, it would not be out of line to obtain the entire cost for the orthotics at the time the casting or scanning was performed.