Off-The-Shelf or Custom-Fitted Orthotic Lookup Tool - JA DME
Browse by DMEPOS Category
- Continuous Passive Motion (CPM) Devices
- Enteral and Parenteral Nutrition
- External Infusion Pumps
- Glucose Monitors
- Hospital Beds
- Immunosuppressive Drugs
- Manual Wheelchairs
- Nebulizers
- Negative Pressure Wound Therapy
- Oral Anticancer Drugs and Oral Antiemetic Drugs
- Orthotics
- Osteogenesis Stimulator
- Ostomy
- Oxygen
- Patient Lifts
- Pneumatic Compression Devices (PCD)
- Positive Airway Pressure (PAP) Devices
- Power Mobility Devices (PMDs)
- Pressure Reducing Support Surfaces
- Prosthetics
- Refractive Lenses
- Respiratory Assist Devices
- Surgical Dressings
- Tracheostomy Supplies
- Therapeutic Shoes
- Transcutaneous Electrical Nerve Stimulators (TENS)
- Urological Supplies
- Wheelchair Options/Accessories
- Wheelchair Seating
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.
Last Updated Fri, 09 Sep 2022 16:49:04 +0000