DME Fee Schedule

First the application of this code, DOES NOT apply to foot orthotics, which unless placed into a shoe attached to a leg brace are not covered by Medicare.

This answer will address L4205 as it applies to orthotic devices which are covered by Medicare.

Often (outside the 90 day global period after dispensing orthotics (e.g. AFO) require an overhaul or replacement of a part which does not have a HCPCS code.

In this case, the labor involved with the repair will be covered separately as L4205 and billed in increments of 15 minutes. Thus anything from 0-15 minutes is billed as 1 unit, 15:015-30: 2 units, etc. The miscellaneous part will be invoiced as L4210 and the cost for this can be separately invoiced based on cost. It should be included in the electronic narrative. Your EMR/EHR software vendor will tell you where to upload the invoice for this.

For repairs to prosthetic devices (e.g. L5000) crosswalk to L7520 and L7510.

Each code is expected to also be invoiced with the use of the KX modifier and the appropriate LT or RT modifier. A good example here would be for replacing a screw on a hinge or a rivot on a hinge.

As for repairing or replacing a part which does have its own HCPCS code (e.g. soft tissue supplment L2820 or replacing a strap (L4002) as they have their own HCPCS code, the labor for replacement is included in the HCPCS code.

These codes are priced based on the state where the patient lives and can be found by searching your DME MAC home page for the labor and payment rates. For other carriers you will need to reviw their payment policies.