Prosthetic and Orthotoc Devices Billing Guide

Washington Apple Health (Medicaid)

Prosthetic and Orthotic (P&O) Devices Billing Guide

August 14, 2017

Every effort has been made to ensure this guide's accuracy. If an actual or apparent conflict between this document and an agency rule arises, the agency rules apply.

Prosthetic and Orthotic (P&O) Devices

About this guide

This publication takes effect August 14, 2017, and supersedes earlier billing guides to this program.

HCA is committed to providing equal access to our services. If you need an accommodation or require documents in another format, please call 1-800-562-3022. People who have hearing or speech disabilities, please call 711 for relay services.

Services, equipment, or both, related to any of the programs listed below, must be billed using their program-specific billing guides:

? Wheelchairs & Durable Medical Equipment and Supplies Billing Guide ? Medical Nutrition Billing Guide ? Home Infusion Therapy Billing Guide

Washington Apple Health means the public health insurance programs for eligible Washington residents. Washington Apple Health is the name used in Washington State for Medicaid, the children's health insurance program (CHIP), and stateonly funded health care programs. Washington Apple Health is administered by the Washington State Health Care Authority.

What has changed?

Subject

Change

Reason for Change

Coverage Coverage Table

Coverage Table

Added section "Billing for occupational Program change therapist evaluation"

Added a symbol (+) to the Coverage Table key that identifies which procedure codes in the Coverage Table are allowed to be billed by licensed occupational therapists

Policy change to align with WAC 182-5432000(1)(e), effective 8/14/2017

Revised policy/comments for the following HCPCS codes to indicate the covered device is limited to 3 per year, instead of 1 per limb, per year: L0112, L0113, L0120, L0130, L0140, L0150

Program change to allow 3 per year. (These codes identify equipment not used on limbs.)

This publication is a billing instruction.

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Coverage Table

Coverage Table Coverage Table Coverage Table Coverage Table

Prosthetic and Orthotic (P&O) Devices

Revised policy/comments for the following HCPCS codes to remove the reference "per limb" from the number of covered devices: L0170, L0172, L0174, L0180, L0190, L0200, L0220, L0450, L0452, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0480, L0482, L0484, L0486, L0490, L0491, L0492, L0621, L0622, L0623, L0624, L0625, L0626, L0627, L0628, L0629, L0630, L0631, L0632, L0633, L0634, L0635, L0636, L0637, L0638, L0639, L0640, L0641, L0642, L0643, L0648, L0649, L0650, L0651, L0700, L0710, L0810, L0820, L0830, L0859, L0861, L0970, L0972, L0974, L0976, L0978, L0980

Housekeeping ? This equipment is not used on limbs

Changed policy/comments for HCPCS code L0982 to "Limit 1 set of 4 per year" instead of "Limit 1 per limb per year."

Housekeeping ? This equipment is not for use on limbs

Changed policy/comments for HCPCS Housekeeping ? This

code L0984 to "Limit 2 per year instead equipment is not for use

of "Limit 1 per limb per year."

on limbs

Added prior authorization requirement Clarification to HCPCS L1020

Added a symbol (+) to the following HCPCS codes to show the service may also be provided by a licensed occupational therapist: L3702, L3730, 3740, L3763, L3806, L3900, L3905, L3906, L3913, L3919, L3921, L3933, L3935

Clarification

Removed limitations from HCPCS codes L1200 and L1499

These are miscellaneous codes. The agency does not limit them as they are reviewed on a case-bycase basis

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Coverage Table Coverage Table

Prosthetic and Orthotic (P&O) Devices

Changed policy/comments column for HCPCS code L3230 to "Limit 1 pair every 12 months" instead of 1 per limb per year"

Housekeeping ? This equipment is not for use on limbs

Added to policy/comments column for Clarification HCPCS code L3600: "See L3620"

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Prosthetic and Orthotic (P&O) Devices

How can I get agency provider documents?

To access provider alerts, go to the agency's provider alerts web page. To access provider documents, go to the agency's provider billing guides and fee schedules web page.

Where can I download agency forms?

To download an agency provider form, go to HCA's Billers and providers web page, select Forms & publications. Type the HCA form number into the Search box as shown below (Example: 13-835).

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