Article Detail - JA DME

Have you billed a claim for an orthotic item that is classified as a custom fit brace, but no custom fitting was performed and there is no equivalent off-the-shelf brace? The medical directors for Noridian and CGS, along with the PDAC published an article titled, Custom Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code - Correct Coding. The article provides instructions on billing with a miscellaneous code when this scenario occurs. Another article was published titled, Correct Billing For Custom Fitted Orthotics When No Custom Fitting Is Completed With No Off-the-Shelf Equivalent that provides detailed instructions on information that should be included in the narrative when billing these claims.

If you have claims that have denied with an MA130 remark code, that means the claim contains incomplete and/or invalid information, and no appeal rights are afforded. If the claim did not include the correct narrative as indicated in the articles’ instructions, add the narrative, and resubmit the claim. If the narrative was included and still denied, please contact the Supplier Contact Center to request a reopening.