Article Detail - JD DME
Do You Have a Question About a Prefabricated Orthotic and How It Should Be Coded and Billed?
We have created an Off-the-Shelf or Custom-Fitted Orthotic Lookup Tool to assist suppliers in determining the proper code to use. Orthoses are listed on the Pricing, Data Analysis and Coding (PDAC) website and are identified as either prefabricated off-the-shelf, prefabricated custom-fitted or custom fabricated. Utilizing this tool will provide you the information you need to determine which code to choose when providing prefabricated orthotics.
There are certain HCPCS codes categorized as custom fitted orthotics for which there are no corresponding off-the-shelf codes. If a prefabricated orthosis is categorized as custom fitted, but is delivered as off-the-shelf, one of the following miscellaneous codes must be used to bill the DME MAC and a narrative included on the claim.
- L1499 - Spinal orthosis, not otherwise specified
- L2999 - Lower extremity orthoses, not otherwise specified
- L3999 - Upper limb orthosis, not otherwise specified
- Narrative to include:
- HCPCS code of item being provided
- OTS to indicate it is off-the-shelf
- Supplier’s retail price (SRP)