Search Results

Do any doctors have any thoughts on Extracorporeal Shockwave therapy ESWT with regards to whether it is covered by traditional Medicare? If answer could relate to New Jersey Medicare, this would be helpful. If covered, what diagnosis codes and procedure codes are used. Also, are there requirements for alternative treatments to be tried first and to fail before Medicare will cover the ESWT. Or, is this a strictly cash payment and not covered by Medicare at all?

I have a non union of a 2nd met and plan on taking a graft from the calc. Code please?

Had a post payment review last year, recouping reimbursement on a $700 Arizona AFO of a diabetic with severe ankle DJD. Have the same scenario now. What documentation, hoops do I have to jump through with documentation to satisfy the Gods and avoid a repayment demand for a similar AFO?

I know we have to provide a sign language interpreter for a deaf patient, but does it have to be an in person interpreter or can it be a virtual interpreter?

Are all DME including therapeutic diabetic shoes amd inserts considered DHS? If so, then how is reimbursement handled in a group practice? Also, according to the attached article the group amd the physician both must be registered with DMERC to dispense DME. Is that correct? In a group practice should every location or office be registered with DME? That is, should every location have a supplier number? And if so, then if a physician is dispensing diabetic shoes/inserts in the office and will be reimbursed by Medicare and is not a registered as a supplier with DMERC is that a breach of the Stark Law? Also, some DME vendors provide direct ship for certain DME products such as dressing supplies, compression garments, etc to the patient home. Is that no longer legal under the Stark Law or that dependent on who is billing for the DME? And can a DME vendor provide any sort of compensation to a physician who is allowing to bill for the DME, but the physician delivers to the product in the office? https://www.healthlawadvisor.com/physicians-beware-groups-providing-dme-prosthetic-devices-and-other-medical-supplies-to-their-medicare-patients-risk-violating-the-strict-liability-stark-law-since-the-expiration-of-covid-19-public

I have a patient, bilateral transmetatarsal amputation. Dispensing diabetic shoes. I am assuming I can bill A5500, A5513 x 3 pairs bilaterally, then what for the toe filler L5000? From what I have seen online CMS only allows 1 unit per year? Am I not paid to have the toe filler on 3 sets of diabetic dual density inserts?

I am confused about the proper codes to be used for treatment of warts. If a patient comes in for an initial visit and I diagnose them with a wart and debride the wart and then apply salicylic acid under occlusion can I bill a new patient EM code and then 17110?   When they return for follow-up am I allowed to bill 17110 again if I debride the lesion and apply salicylic acid once again? The definition of the code 17110 includes the term chemosurgery but I am not sure if salicylic acid is included as it is keratolytic. I have always billed EM codes but recently I was told that was incorrect.

Queries: Rejected Claims for Medicare DME to Novitas Solutions  Has anyone had recent issues with rejections of claims for DME products (i.e. L4360 CAM walker)  We have been submitting these claims with laterality and KX modifiers, now out of nowhere they are rejected saying invalid information as specified in status details . We have tried new modifier combos, just -RT or-LT, just- KX, added -NU, none work . We called them and they said modifiers are incorrect but would not tell us what to use since that info is locked up with the nuclear codes. If something has changed they never informed us.  Anyone else with the same issue or any suggestion appreciated.  Larry Goldstein, DPM,  Warner Robins, GA

Good morning again (just posted a similar question on a different device) I was approached about an implantable device for pain control: The Morph Device (https://themorphdevice.com/) The billable codes theyre saying are 0720T and 64553. Now 64553 is payable by medicare (this device is not payable to podiatrists, but it is to NPs to which I employ). The 0720T code don't show in the Medicare fee schedule, neither code is linked to any LCD, but the rep provided EOBs showing payments. Which I know isnt guarantee of being a legitimate. I'd like to be buy the book if possible. While avoiding future clawbacks as well. 1-How does one look at the documentation or program requirements to properly document these codes? 2-Any other advice? Thank you! Luke

A diabetic patient is referred to me for an evaluation by her PCP. The patient has no complaints other than that. Is this a billing service under Medicare if they have no complaints?