Recently inquires have been received regarding the proper use and billing for HCPCS code L3000. This code describes a shoe insert billed when provided with an orthopedic shoe attached to a brace.
L3000—Foot, insert, removable, molded to patient model, 'UCB' type, Berkeley shell, each
Suppliers and providers are reminded that orthopedic shoes are excluded from coverage by the Social Security Act (SSA), Section 1862(a)(8) except in very limited circumstances, described below. In addition, the Act specifically excludes treatment and devices for flat feet, subluxations of the foot and routine foot care (see SSA Section 1862(a)(13)). The only exceptions to these benefit category provisions are:
Use of an orthopedic shoe(s) attached to a brace in which case coverage is governed by the brace/orthotic benefit in the Act Section 1861(s)(9) with additional guidance in the CMS IOM 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 130. (1 MB) CMS IOM Publication100-04, Medicare Claims Processing Manual, Chapter 20, (631 KB) various sections) and the DME MAC LCD and related policy article titled Orthopedic Footwear.
In other words, orthopedic shoes, inserts and modifications may only be billed when attached to a brace, in which case the shoes, inserts and/or modifications must be billed by the supplier billing the brace or as a substitute for inserts in beneficiaries entitled to therapeutic shoes and inserts by virtue of a diabetes diagnosis.
For additional information on the proper coding, coverage and documentation requirements for orthopedic shoes, inserts and modifications refer to the DME MAC local coverage determination and related policy article titled Orthopedic Footwear.
