Billing for orthotic or prosthetic supplies

mcohen@blr.com

Can a hospital bill for orthotic or prosthetic supplies like a leg brace fit to 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? 

valerie@valorizeconsulting.com

CMS states in the Claims Processing Manual Chapter 4 Section 20 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 DMEPOS fee schedule, prosthetic and orthotic supplies are not DME, so these are allowed to be billed under the hospital 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.