“I am looking for clarification regarding dispensing a post-operative shoe in conjunction with performing a surgery (days before surgery, day of surgery or days following surgery). Can we have patients pay out of pocket for the device? Does the payer, Medicare or commercial carriers, factor into the rules?”
When it comes to the dispensing of a postoperative, surgical shoe, the appropriate HCPCS Level II code is L3260 which is defined as the following: Surgical shoe/boot, each. With respect to Traditional Medicare, a postoperative shoe is NOT separately payable when it is dispensed in conjunction with a surgical procedure code. It is considered to be part of the procedure. Like orthotics, this item is a statutorily excluded benefit by Medicare and DME and will not be covered under any circumstances.
In reality, the shoe is considered to be part of the dressing. Regarding the fact that the surgical shoe is considered to be part of the procedure, it does not matter what procedure is being performed. It is included in the reimbursement for any CPT/procedure code, whether the CPT/procedure code is classified as a Minor Surgical Procedure (postoperative global period of “0” or “10” days) or a Major Surgical Procedure (postoperative global period of “90” days). NO, you should not have the patient sign an ABN and charge the patient for the shoe.
As far as Medicare Advantage Plans and Commercial Health Insurance Plans are concerned, it is possible that the postoperative, surgical shoe, L3260 IS reimbursable. It would behoove the practitioner to confirm in advance of performing the procedure, whether or not HCPCS Level II code L3260 is reimbursable for the procedure and whether or not it is included in the reimbursement for the procedure. If L3260 is a reimbursable HCPCS Level II code for the procedure that is being performed, wonderful! Bill the code! If it is not reimbursable for the procedure being performed and it is not included in the reimbursement for the procedure, bill the patient!
Last point. Since HCPCS Level II code L3260 is in reality a POSTOPERATIVE, surgical shoe and if it is reimbursable for the procedure that is being performed, I would not dispense and bill HCPCS Level II code L3260 until the day of surgery.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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