I am a bit confused over what is the proper code for casting/scanning/or using bio foam when taking a negative impression for foot/ankle foot orthotics?
This is multiple questions rolled into one and that the reimbursement for any code(s) are all dependent on the carrier.
Let’s start with never bill using the “Q” codes as these supply code represents a specific type of cast and materials used when casting a patient for a sprain or fracture. Beyond that, the answer is different for bio foam and scanning than it is for plaster or fiberglass casting.
For bio foam and scanning, whether for an AFO or foot orthotic, there currently are no specific codes describing the actual negative impression employing those techniques.
For casting a patient for an ankle foot orthotic (AFO) there is no specific code describing this procedure. In this scenario, CPT 29799 (miscellaneous casting) may be the only CPT code reflecting this procedure.
As for casting a patient (fiberglass or plaster) for foot orthotics, providers have two choices for coding:
S0395 defined as: Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic. This is the case for most podiatrists or other professionals who send the casts to a laboratory for manufacture of the foot orthotic;
or
29799: Other casting or strapping procedures
Irrespective of the scenario, for Medicare, the impression for orthotics (e.g. AFO) is included in the pricing for the brace and thus not separately covered.
For private insurance carriers for AFO and foot orthotics, the reimbursement for S0395 or 29799 are most often always covered within the L code for those products. Contact your third-party carrier to determine whether the impression is global to the HCPCS code and whether they will accept the S0395 or 29799.
In the rare scenario where a carrier will provide separate coverage for the impression it is important not to bill for the impression and the device on the same date of service. Clear documentation of what technique was performed for the impression. Never bill for the 29799 and S0395 on the same date of service.
