Does your office provide orthotics to patients? For some therapists they provide an important treatment option for many conditions physical therapists treat. However, if you and your staff aren’t fully trained on how to bill for orthotics properly is can be a financial disaster.
Insurance Coverage and Verification
Insurance coverage for orthotics will vary by carrier and policy. Always check if orthotics is a covered benefit under the patient’s policy. More often than not, after a lengthy verification process you will find out that orthotics are not covered and the patient will have to pay cash. If you are out-of-network with the patient’s insurance or if the patient would like to try and bill their insurance themselves you can provide them with a letter of medical necessity and the correct CPT and HCPCs codes. Other options for patients may be the use of flexible spending accounts and Health Savings Accounts.
Here are some questions to ask when verifying orthotic benefits:
- Are custom-molded foot inserts (orthotics) covered and billed as code L3030/L3020?
- Are there condition related limitations?
- Are orthotics or other DMEs part of a separate policy benefit?
- Is a prescription from a physician required?
- Are custom-made orthotics subject to a separate co-pay or co-insurance?
- Are these products subject to the deductible?
- Are there certain diagnosis codes necessary for reimbursement under the policy?
Let’s face it, orthotics, especially custom orthotics, are not cheap. Typical custom orthotic charges range from $400-$600. Collecting payment for dispensed orthotics really should be a priority for your office. Be upfront with your patients about your fees to allow them the opportunity to decide if they wish to proceed if their insurance company does not pay for them. We recommend creating a form that details the cost of the orthotics and all associated charges (casting, adjustments, additional pairs etc.) It’s also a good idea if the patient does not have orthotic benefits to collect 50% of the cost up front, and the remaining balance when the patient receives their inserts.
When’s the last time you’ve checked your fee schedule to see what your office is charging for orthotics? Okay, when’s the last time you reviewed your invoices from your suppliers to see how much they are charging you for the orthotics? It’s a good idea to periodically make sure you’re at least charging insurance companies and patients your cost for supplies so you aren’t losing money.