Good Morning List,

We have a podiatrist that is having custom orthotics made for his patients. We have been using L3000 per his instructions but Medicare is denying. These orthotics are custom molded insole inserts. Is anyone using something else?

Thanks for your help.


Delma Scheidel , CPC
245 Alvord Park Road
Torrington, CT 06790
860-482-8539 Extension 279
Fax 860-482-0258
Email: dscheidel@lhoa.com


  • blockquote, div.yahoo_quoted { margin-left: 0 !important; border-left:1px #715FFA solid !important; padding-left:1ex !important; background-color:white !important; } Orthotics are a non covered service with Medicare. No other code

  • That is the right code, goes through DME carrier and isn't covered for the most part. We bill it through to them with the GY modifier

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor

  • rthopedic Shoes — HCPCS Code L3000 - Billing Reminder

    Recently inquires have been received regarding the proper use and billing
    for Healthcare Common Procedure Coding System (HCPCS) code L3000.This code
    describes a shoe insert billed when provided with an orthopedic shoe
    attached to a brace.

    Suppliers and providers are reminded that orthopedic shoes are excluded
    from coverage by the Social Security Act, �1862(a)(8) except in very
    limited circumstances, described below. In addition, the Act specifically
    excludes treatment and devices for flat feet, subluxations of the foot and
    routine foot care (see SSA �1862(a)(13)). The only exceptions to these
    benefit category provisions are:

    1. Use of an orthopedic shoe(s) attached to a brace in which case
    coverage is governed by the brace/orthotic benefit in the Act �1861(s)(9)
    with additional guidance in the Medicare Benefit Policy Manual
    (Internet-only Pub. 100-2, Chapter 15, Section 130), the Medicare Claims
    Processing Manual (Internet-only Pub. 100-4, Chapter 20, various sections)
    and the DME MAC LCD and related policy article entitled *Orthopedic
    2. For persons with diabetes *only*, substitution of modification(s) of
    custom-molded or depth shoes instead of obtaining a pair(s) of inserts in
    any combination. Payment for the modification(s) may not exceed the limit
    set for the inserts for which the individual is entitled.

    In other words, orthopedic shoes, inserts and modifications may *only* be
    billed when attached to a brace, in which case the shoes, inserts and/or
    modifications must be billed by the supplier billing the brace or as a
    substitute for inserts in beneficiaries entitled to therapeutic shoes and
    inserts by virtue of a diabetes diagnosis.

    For additional information on the proper coding, coverage and documentation
    requirements for orthopedic shoes, inserts and modifications refer to the
    DME MAC local coverage determination and related policy article *Orthopedic
    Shoes* at http://www.cms.gov/medicare-coverage-database/overview-and-quick-

  • We have used L3020 for the custom molded insoles

  • The code needs to be based upon the type of insert, the type of support,
    sometimes the type of material and of course whether it is custom made.
    L3020 has to have both longitudinal and metatarsal support, L3010 is
    longitudinal only and L3000 is a UCB type which means it has support that
    also comes up around the heel medially, laterally and posteriorally. There
    is also L3030 which is custom molded to the patient. No metatarsal pad.
    You cannot say that all of the custom inserts are billed with one code.

    All of these fall under the therapeutic shoes benefit. From everything I
    have read, they are not covered for Medicare patients unless they are part
    of a brace and shoe system.

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