Q&A: Billing for orthotic or prosthetic supplies

Wednesday, February 7, 2018

Q: Can a hospital bill for orthotic or prosthetic supplies (e.g., leg brace for a patient in the ED or clinic) on the hospital claim? What are the requirements for billing these supplies? Is revenue code 0274 the correct revenue code? Are HCPCS codes needed?

A: In the Claims Processing Manual in chapter 4, section 20, CMS states that hospitals are allowed to bill prosthetic and orthotic supplies (POS) on their UB claims to their MAC. While the fee schedule for POS is under the Durable Medical Equipment, Prosthetics/Orthotics & Supplies (DMEPOS) Fee Schedule, prosthetic and orthotic supplies are not DME, so these are allowed to be billed under the hospital Centers for Medicare and Medicaid Services Certification Number (CCN) on the regular UB claims. Implantable POS are usually under the revenue codes for implants and may have C codes. Non-implantable POS are typically billed with a HCPCS code under revenue code 0274 on outpatient claims. Care must be taken when coding accounts to ensure that a clinic visit code of G0463 is not added to an account if the sole visit was to fit and adjust the POS because that is typically included in the definition of the POS code itself.

Note: This question can be found in the billing and claims section on the NAHRI Forums where you can find answers to questions on a variety of topics from billing and claims to compliance to reimbursement. This question was answered by Valerie Rinkle, MPA, lead regulatory specialist and instructor in Middleton, Massachusetts, for HCPro.