Off-The-Shelf or Custom-Fitted Orthotic Lookup Tool - JA DME
Off-The-Shelf or Custom-Fitted Orthotic Lookup Tool
Utilize this tool to assist in determining the correct HCPCS code in billing prefabricated orthotic claims. Is the orthotic off-the-shelf or custom-fitted or is there a corresponding code that may be billed depending on the action taken at time of delivery? Off-the-shelf requires minimal self-adjustment and custom-fitted requires more than minimal self-adjustment by a certified orthotist or an individual who has equivalent specialized training.
Note: If a Custom-Fitted code displays with the Corresponding Code = None and you are providing orthotic as Off-the-Shelf
Review the Correct Billing for Custom Fitted Orthotics when no Custom Fitting is Completed with no Off the Shelf Equivalent webpage which states:
- Bill one of the miscellaneous codes as there is not a corresponding prefabricated off-the shelf HCPCS code.
- L1499 - Spinal orthosis, not otherwise specified
- L2999 - Lower extremity orthoses, not otherwise specified
- L3999 - Upper limb orthosis, not otherwise specified
- A narrative must be included on the claim with the following information.
- HCPCS code of item being provided
- OTS to indicate it is off the shelf
- Supplier's Retail Price (SRP)
Example: L1820 OTS $150 SRP
Additional Information can be found on the Custom Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code - Correct Coding webpage.
Disclaimer: This tool does not guarantee coverage for the item(s) billed.
