Podiatry Updates for Orthotics and Routine Foot Care

BCBS IL clamped down on DME recently with their significant fee cut. In addition, we have received a large number of complaints from our clients stating that Blue Choice plans only allow coverage for one pair of orthot- ics, even though no limitation is mentioned over the phone upon verifying benefits. After speaking with a BCBS IL representative, we recommend only billing one pair for your Blue Choice patients, or collecting money up front for a second pair.

As a result of Medicare’s audit of claims billed with both visit and nail debridement codes, they have seeming- ly made it a new policy to deny any visit codes that are billed with 11720/11721. This even applies to visits for new patients. For your established patients, if your notes support a separate visit (for example the patient is seen to evaluate an ankle sprain and routine nail debridement), continue to bill both codes. However, for your new patients, if you perform both an initial history/evaluation and a nail debridement, only bill the new visit code in order to receive maximum reimbursement.

Regarding routine foot care, more Medicare replacement plans (Humana is the most common offender) have been denying 11721 when billed with 11055/11056/11057. While original Medicare continues to pay both of the procedures when billed together, the replacement plans are doing so less and less despite our many appeals and complaints.