Article Detail - JD DME

Posted March 18, 2011

When billing for replacement of Orthopedic Footwear that is an integral part of a leg brace it is necessary for the following information to be documented in the NTE 2300 or NTE 2400 segment of the electronic claim or Item 19 of a paper claim:

• Indication that the shoe being replaced is part of a brace

• The HCPCS code for the brace

For example: "shoe being replaced is part of a brace (HCPCS L1900)"

All other applicable modifiers must be appended to the HCPCS code including:

The KX or GY modifiers: When billing for a shoe that is an integral part of a leg brace or for related modifications, inserts, heel/sole replacements or shoe transfer, a KX modifier must be added to the code. If the shoe or related item is not an integral part of a leg brace, the KX modifier must not be used and the GY modifier must be appended.

The right (RT) and/or left (LT) modifiers must also be used with all footwear HCPCS codes in the Orthopedic Footwear LCD. When the same code for bilateral items (left and right) is billed on the same date of service; bill for both items on the same claim line using the RTLT modifiers and 2 units of service.

The RB modifier which is for the replacement of a part of a DME, orthotic, or prosthetic item furnished as a part of a repair must be appended to the HCPCS code for the replacement footwear.

Shoes which are incorporated into a brace must be billed by the same supplier billing for the brace. Shoes which are billed separately (that are not a part of a brace) will be denied as noncovered. A KX modifier must not be used in this situation.

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