Samuel A. Collins
Q: I am going to begin prescribing and dispensing foot orthoses. How do I bill for that service?
A: Foot orthoses, or as they are commonly known, "orthotics," can indeed be a service provided by a doctor of chiropractic. But billing for that service involves more than simply billing for the foot orthotics, but also for all the related services that require the time and expertise of the chiropractor.
First up is a history and examination of the patient, which is billed under the appropriate evaluation and management (E&M) code. The actual foot orthotic, if custom-made, would then be billed under the HCPCS code of L3030, which is a level-2 HCPCS code specific for a foot insert, removable, and formed to patient foot (custom-made). If it is a premolded, noncustom insert, the code would be L3060. These codes indicate a single foot orthotic; therefore, they should be billed separately with the modifier LT for one and RT for the other (this indicates left and right).
If the orthotics are custom, it is likely that you will send out the castings to a company that produces the custom inserts. Consequently, you would bill for the time for handling and conveyance connected with sending these items, using the code 99002. The cost for this is typically $15 to $20, depending on mailing costs. If the orthotics are not custom, the time spent fitting and training (how to insert, use of the proper shoe, length of time to wear, etc.) is billed under 97760 - Orthotic Management and Training. This is a 15-minute code; therefore, if 30 minutes of time is spent, it could be billed for two units.
Typically, there is a follow-up in one to four weeks; at that time, the code 97762 would be billed for Orthotic Checkout. This is to assess the use of the inserts and to ensure the goals and progress are being attained. This is also a 15-minute code and is billed in units, if necessary.
For many patients, foot orthotics can help correct spinal conditions; as such, they constitute an accepted method of care and management. Nonetheless, it is still wise to include a letter of medical necessity and explanation with the initial billing. The letter should highlight that the patient has a spinal condition related to instability of the feet, lower extremities, pelvis and spine. It also should highlight that the instability causes an inability to equally and correctly distribute weight when standing or walking, causing an abnormal biomechanical strain. Finally, the letter should point out that the orthotics are designed to stabilize and correct these imbalances, and that they were custom-made and/or fitted to improve the structural integrity of the spine and lower extremities.
