The last three installments in this forum dealt with the first three steps of required documentation for reimbursement for custom foot orthotics. To summarize those steps were proper clinical documentation of medical necessity to meet the merits of the third-party payer’s policy, the required elements of the fabrication/prescription process and most recently the fitting/adjustment and dispensing of the device.
The final step in the proper documenting of prescription custom foot orthotics is proper billing. There are three HCPCS codes generally accepted for custom foot orthotic billing, including L3000, L3010 and L3020.
There are required essential elements for each of the above codes which if not properly documented can result in claim denial upon audit. This column will discuss HCPCS code L3000.
Before we start to review the above codes in detail, it should be noted that the HCPCS code set for custom fabricated orthotics were developed in the 1960’s prior to modern theory of biomechanics, and current materials and fabrication processes. The infamous quote from Mr. Robinson to Benjamin (Plastics) comes to mind as the current array of plastics were not widely in vogue back in the mid 1960’s. With that in mind, the purpose of this installment is to provide both the reader and third-party payers with a workable consistent modern interpretation.
L3000: The original L3000 was designed and developed at the UCBL and is trademarked. It had a very deep heel cup and was not made from the current array of thermoplastic materials, thus a very deep heel cup was required to attain correction. Because UCBL no longer manufactures these devices, one could theoretically say that no one can currently submit a claim for L3000. However, the more modern interpretation of this describes this as a UCB Type rather than UCBL. Other requirements for L3000 should include that it is made from raw materials and has a sufficiently deep heel cup (10mm or more) and a sufficient durometer and thickness for the thermoplastic to meet the required correctional requirements for the patient’s clinical condition. The device should have the ability to provide medial and lateral corrective forces to control the hind and forefoot. In simple terms, one would not use a 5mm heel cup and cork and soft leather device for a patient to correct a flexible rearfoot varus and expect that to stand up to audit. Your laboratory’s description should only refer to specific devices meeting the other features of an L3000 as a UCB Type device. Lastly there are no add on HCPCS codes to describe posting, accommodations, cut outs, etc.
