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Old 06-10-2011, 03:01 PM
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Default Medicare Payment for L3000

Perusing the DME fee schedule, I saw that there is an allowable amount for L3000. I was not aware of any conditions when the L3000 code was Medicare covered.
Is this an error on Medicare's part in terms of including the code as a fee schedule item or are there actually scenarios when it Medicare pays for it.
Harry told me that he had once had you research this. He said that you found a statement that if L3000 was used in a situation where a shoe with attached brace was used, the L3000 would be allowed. That is the only way. He hasnít seen the actual citation. If this documentation exists and you have it, please send copies to Harry and I.


I am very confused when billing for custom made orthotics. For non-diabetics I bill L3200, for diabetics I am not sure if I should bill L3000 or or L5000. When I billed L3000 I was paid by Medicare


According to Medicare's Orthopedic and Footwear Local carrier Decisions (LCD) L3000is covered only if both:
1. The shoe into which the foot orthotic will be placed is an integral part of a leg brace.
2. The orthopedic shoes which is attached to the leg brace was supplier to the patient by the same supplier who provided the brace.

Just because a code has a reimbursement amount does not mean that payment is justified.

Diabetic Medicare patients who have loss of protective threshold with callus formation OR decreased circulation OR a foot deformity OR a history of ulceration or amputation qualify for up to three pair of either heat molded prefabricated (A5512) or custom molded (A5513) inserts.

To qualify for a longitudinal arch support with partial foot filler (L5000), the supplier should document that the missing segment of the foot adversely affects gait and place the foot at increased risk of further change and that the use of the filler improves gait and protects the footis..
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