Orthotics

Were you aware that the highest-earning 1% of podiatrists distribute more than 10 pairs of orthotics each week? Nonetheless, most podiatrists fall short of maximizing their earnings potential with orthotics. For many podiatrists, orthotics foot orthotics are an underperforming or overlooked profit center in their practice. But why?

REGCLR7 - Use of Ankle Foot Orthotics to Improve Patient Function

“If orthotics are not covered by Medicare, if the KX modifier is appended to L3000-RT and L3000-LT, I am getting paid. Is it wrong to use the KX modifier to get paid for orthotics?”

“Is there a foolproof way to deal with the “Medicare doesn’t cover orthotics” issue? Is there an article that explains to the irate patient on the difference between functional orthotics and diabetic insoles and what is covered by Medicare? In this scenario, we typically explain to the patient that orthotics for plantar fasciitis are not covered. We have them sign an ABN and we can easily send the L3000 into Medicare with the GY modifier. We can share this with the patient and they can see that it is not covered. However, what can we do when the patient calls Medicare themselves and are told that orthotics are covered?”

“I read the Medicare DME requirements for diabetic shoes and inserts. I am still confused and am seeking clarity. I know for diabetic shoes, it requires a MD/DO to certify that patient has diabetes with neuropathy and thus, qualifies for diabetic shoes and 3 custom insoles. It is my understanding that Medicare only covers orthotics if the patient is diabetic and as stated above, is certified to have diabetes with neuropathy. I have seen other physicians use the KX modifier to get orthotics incorrectly paid. My question is: If I just want to dispense the custom molded diabetic insoles (three pairs of orthotics/diabetic insoles as allowed by Medicare — and not the shoes), are there separate rules or are they the same rules? Is it legal to do a cash pay for diabetic/soft custom insoles? Any other tips you have found useful in your practice? Have you in your practice just dispensed the insoles and not the shoes?”

Recently there was a report in a publication received mostly by Orthotic and Prosthetic (O&P) providers (mostly orthotists, prosthetists and pedorthists) that created quite a stir for several podiatrists They thought based on this story, that the sky was falling and that DPM's were no longer going to be able to provide certain DME services in 17 states where licensure requirements are in existence.

An opinion on when you need Business Associate Agreements when working with Durable Medical Equipment Vendors.