tci Outpatient Facility Coding Alert - 2012 Issue 6
Reader Question: File L3260, But Don't Expect Extra Pay
Question: Do insurance companies pay for footwear in an ASC, such as surgical boots? Answer: Under Medicare, codes for certain supplies such as L3260 (Surgical boot/shoe, each) often fall under the category of "special coverage instructions." In the instance of L3260, the supply is covered when provided in an ASC setting, but the payment is already included in payment for the primary procedure or service. Non-Medicare payers often follow suit, but some may provide additional reimbursement. Include the code on your claim, but realize that you likely won't get separate payment. Leg, arm, back and neck braces, on the...
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