Noridian responds to orthotics inquiries 

WASHINGTON – Noridian Healthcare Solutions has published an update for billing custom-fitted orthotics when no custom fitting is completed with no off-the-shelf equivalent available. “Due to recent inquiries from suppliers, it has come to our attention that some miscellaneous codes used for billing off-the-shelf orthotics, when a custom fit orthotic is provided but no custom fitting is performed, may require specific policy and laterality modifiers,” it states. These claims must also include a narrative with this information: 

Miscellaneous Codes 

When no corresponding prefabricated off-the-shelf HCPCS code is available, use one of the following codes: 

• L1499 - Spinal orthosis, not otherwise specified 
  • Apply any policy-specific modifiers as required 
• L2999 - Lower extremity orthosis, not otherwise specified 
  • Apply any policy-specific modifiers as required 
  • Use RT or LT modifiers as appropriate 
  • For bilateral items on the same date of service, list each item on a separate claim line with the RT and LT modifiers and 1 unit of service (UOS) on each line (e.g., L2999 RTKX) 
• L3999 - Upper limb orthosis, not otherwise specified 
  • Apply RT or LT modifiers as appropriate 
  • For bilateral items on the same date of service, list each item on a separate claim line with the RT and LT modifiers and 1 unit of service (UOS) on each line (e.g., L3999 RT) 

Narrative Requirement 

Include a narrative on the claim with the following information: 

• HCPCS code of the item being provided 
• Indication of "OTS" (off-the-shelf) 
• Supplier's Retail Price (SRP) 

If providers have received denials for these claims, they should correct and resubmit them or pursue redeterminations through the appeals process. Noridian encourages providers to use the Noridian Medicare Portal for Redeterminations/Appeals submissions. Go here to read the full announcement.