Many clients have asked beyond the HCPCS codes for custom fabricated foot orthotics and casting code, what other HCPCS or CPT codes are available for reimbursement?
Gait analysis: Many providers have suggested that the correct Current Procedural Terminology (CPT®) code for gait analysis is 96000-96004. In researching these codes it is apparent that the use of these codes requires real time video analysis of many anatomical body parts not limited to the distal lower extremity. Spinal, hip, knee and head movements must all be incorporated into these studies. The traditional computerized gait analysis takes place in a dedicated gait (motion) analysis laboratory. In the future as technology advances, perhaps a new CPT® code will be introduced to be reflective of the computerized information podiatrists and other lower extremity specialists can perform in their offices.
Orthotic Management and Training:
There are two CPT® which have the potential to describe the actual dispensing of custom foot orthotics. CPT 97760 (Orthotic management and training initial orthotics encounter) and 97763 (orthotics an management and/or training, subsequent encounter) are two codes frequently misused by lower extremity providers to describe fitting, adjustment and the dispensing of foot orthotics. Each of these codes is billed in 15-minute encounters.
If one was to research this code in depth, one would find that the intent of these codes was to be used not by the entity providing the device, but by a physical therapist who is teaching the patient how to use the device. Second and as important is that the HCPCS code and policies of most third-party payers covering foot orthotics assume that the provider who cast the patient will be dispensing it. Thus, the reimbursement for L30XX code includes the actual provision of the device and any required adjustments and its actual dispensing.
Third is that the fifteen-minute component to spend with the patient in teaching them how to use the device by the health care provider (not ancillary staff) would be very difficult if not impossible to defend.
Having audited hundreds if not thousands of claims for custom foot orthotics, it is apparent that there is abuse of both CPT and HCPCS codes which have been previously described in the past few articles on custom foot orthotics.
By now it should be apparent that as with all medical documentation a good history and physical is required to establish medical necessity. The order form and technique by which the negative image was obtained must be carefully completed. The actual fabrication process should be described (this most often can be obtained from the laboratory). The medical record should be able to defend the HCPCS code and all the required paperwork to support the dispensing and fitting (WPOD) should be completed.
(CPT®) is maintained by American Medical Association
