RETIRED - Therapeutic Shoes Modifiers Billing Reminder

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Current direction on correct coding is in the TSPD Policy Article

Posted May 20, 2011

The RT (right) and/or LT (left) modifier(s) must be used when billing shoes, inserts, or modifications. If bilateral items are provided on the same date of service, claims should be billed for both items on the same claim line using the RTLT modifiers and 2 units of service. Claims billed without modifiers RT and/or LT will be rejected as incorrect coding.

Suppliers must also add a KX modifier to codes for shoes, inserts, and modifications only if criteria 1-5 in the "Non-Medical Necessity Coverage and Payment Rules" section of the Therapeutic Shoes for Persons with Diabetes LCD Policy Article have been met. This documentation must be available upon request. The Statement of Certifying Physician form is not sufficient to meet this requirement.

Example: If criteria 1-5 of the policy have been met and the supplier is providing 2 units of A5500 (For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi- density insert(s), per shoe)

Correct billing: A5500RTLTKX 2 units of service

Refer to the Therapeutic Shoes for Persons with Diabetes LCD for additional information.

            Last Updated Thu, 10 Jan 2019 12:19:06 +0000