MSI Orthotic Lab
4646 S. Ash Ave.
Tempe, AZ 85282
Hours: Monday thru Thursday 8AM - 4PM
Orthotic Plus ™
MSI is proud to announce the Orthotic Plus™ System
Introduction: Many patients fail, or have incomplete resolution of symptoms with Custom Foot Orthotic (CFO) therapy, and for a number of reasons either refuse to advance to Ankle Foot Orthotic (AFO) therapy, or are non-compliant with the use of their AFO.
Goals: Facilitate treatment of patients who have failed, or have limited resolution of symptoms with standard CFO therapy, or refuse to wear more controlling (AFO or SMO) because of vanity, shoe issues, etc.
Allow for greater midfoot control when clinically indicated to increase the likelihood of success. Before the Orthotic Plus™ system, the two available options have been using hard flanges (questionable tolerance with adults), or soft flanges (more of a spacer).
The Orthotic Plus™ should offer mechanical control, and, likely, a proprioceptive element influencing the midfoot.
Indications: Fill in the gap where a standard CFO is inadequate and AFO's (and orthoses with deeper heel cups or SMO's) are not a choice due to patient non-compliance.
I. Patients who have failed standard CFO therapy for:
A. Symptomatic Pes Planus
B. Plantar Fasciitis
C. Sinus Tarsi Syndrome
D. Posterior Tibial Tendonitis (Grade 1)
E. Severe Rear and/or Forefoot deformity
II. Moderate to Severe Posterior Tibial Tendonosis (Grades 2 and 3) when AFO therapy is refused.
III. Post immobilization tears of PTT and Plantar Fascia
IV. Tarsal Coalition
V. Need for additional mid/rearfoot support
Contraindications: Neuropathy and Edema
Coding Guidelines: ICD10 Coding: Same or Similar to CFO, SMO and AFO
HCPCS Coding: L3000 UCB Type Orthotic
L2270 Varus Valgus Strapping
Medicare: Foot Orthoses are a non-covered service. Claims may be submitted to your DME MAC with each HCPS code amended with the "GY" modifier in order to obtain a "Patient Responsibility" (PR) and for the claim to pass onto the patient's secondary carrier.
Non-Medicare: L3000 LT or RT, or LT and RT L2270 LT or RT, or LT and RT
1. Can the above be billed unilateral or bilateral?
It has been customary for foot orthoses to be billed bilateral irrespective of a bilateral pathology. Historically, this can be defended so as to avoid creating a limb length discrepancy resulting from the use of a unilateral foot orthosis.
The Orthotic Plus system uses a proprietary (patent pending) strapping system to provide additional support to the mid and rearfoot. If your patient's medical records do not sufficiently illustrate the need for this additional strapping system on the unaffected limb, this "add-on coding" may not be deemed medically necessary by the patient's insurance carrier.
MSI encourages its clients to contact your patient's insurance carrier prior to fabrication in order to obtain both pre-authorization and pre-determination of benefits.
2) Will Medicare pay for the L2270 (as it is covered with AFO codes)?
Medicare's policy is that it will not cover "add-on codes" when the parent code (in this case L3000) is not covered. See previous for more information.
3) If the private carrier pays for L3000, but not L2270 (or vice versa), can I balance bill the patient for the services which were not paid?
This will depend on the nature of the rejection and your contractual obligations with the carrier.
Contracted providers: If the reason for rejection is that the add-on codes are a non-covered benefit you may be able to balance bill the patient.
If the carrier deems the add-on coding is not medically necessary you may not be able to balance bill the patient.
For non-contracted providers: This will depend on the nature of the agreement you provided your patient prior to fabrication.
4) Will MSI retrofit a custom fabricated orthosis to incorporate the system?
If the custom foot orthosis was fabricated by an outside lab, MSI cannot be responsible for damages which may occur to the device. MSI reserves the right to turn down the retrofit, due to whatever cause, e.g., too flimsy, or materials that cannot be matched.
The above information is provided as a guide to assist you with coding and pricing by our coding consultant, Dr. Paul Kesselman. No implied guarantee of payment or compliance is conferred with the use of this document. Coding and compliance are the responsibility of each provider. Your office is strongly encouraged to contact each patient's insurance carrier and obtain current documentation for each policy.