“I am reading conflicting information regarding the dispensing of a post-operative/cast shoe. Medicare never seems to pay for this but commercial carriers usually do. I am reading that this shoe is NOT separately payable when it is dispensed in conjunction with a surgical procedure code. You cannot have the patient sign an ABN and charge the patient for the shoe. Please clarify the dos and don’ts of using the L3260 HCPCS code.”
HCPCS Level II code L3260 is defined as: SURGICAL BOOT/SHOE, EACH. A postoperative shoe is NOT separately payable when it is dispensed in conjunction with a surgical procedure code. It is considered to be part of the procedure. In reality, the shoe is considered to be part of the dressing. NO, you cannot have the patient sign an ABN and charge the patient for the shoe. However, there are certain commercial health insurance carriers that will pay for the surgical shoe. Bill them! You need to confirm coverage and reimbursement for the surgical shoe in advance of dispensing the shoe preferably in writing from the health insurance carrier.
In effect, you might say that per Medicare, HCPCS Level II code L3260 is statutorily non-covered. When you access the LCD Orthopedic Footwear (L33641) and the related Article Orthopedic Footwear – Policy Article (A52481), I would ask you to please focus on the section entitled “Article Text: NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES,” it clearly states that HCPCS Level II code L3260 is non-covered and why it is non-covered.
This is my opinion.
Dr. Michael G. Warshaw
DPM, CPC
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