Medicare billing instructions as worded by SADMERC are as follows:
The allowance for a pre-fabricated orthosis includes all components at the time of initial purchase including, but not limited to, soft interfaces, strap closures, etc. Replacement components of covered orthosis are covered if the original component is no longer functional due to wear and cannot be repaired. Replacement components (e.g. soft interfaces) that are provided on a routine basis, without regard to whether the original item is worn out, are not covered.
One unit of service of the replacement interface HCPCS code is covered no more often than once every 6 months. The replacement with HCPCS code L2999 must be billed with a "not otherwise specified" code. The claim must include a description of the component provided, the reason for replacement, and the HCPCS code or narrative description of the base orthosis.
For further information, please visit the Palmetto GBA Coding Bulletin which can be viewed here.
FILING CLAIMS UNDER HCPCS CODE L2999 FOR ADJUST-A-STRAP SUPPORT
Claim forms MUST include the following:
Product Name:
Adjust-A-Strap Support
Manufacturers:
Whitman Corp.
Reason Why Prescribed:
Drop Foot
Eighty percent of claim up to $140.00 will be paid if filed properly.
