Can orthotics be mailed to the patients?

This is a great question but it is almost impossible to answer universally. Most insurance companies include fitting and dispensing within the HCPCS code for whatever orthotic device you are providing. This includes all orthotic devices for any body part. Not just foot devices. The delivery in the manner using a third party even with proof of delivery contains no support for actually fitting the patient with the device and making any adjustments.

For many third party non Medicare payers, this has been one of the biggest issues where there is no proof of in office delivery and fitting. There have been many legal actions taken against DPMs and other providers in many states by certain carriers. Some have been succesful in recouping a great deal of money and others despite being succesful are very expensive to defend.

Fortunately, there is a workaround. Medicare, which is what most insurance companies use as the reimbursement model, has the solution for cases where the patient does not return to the office despite several attempts to contact them to schedule an appointment for fitting, adjustments and dispensing.

In the Internet Only Manual, Medicare has a document which discusses:

"Custom fabricated Items Cancelled By Patient"

This allows the provider to bill the insurance carrier when the patient cancels a custom fabricated item. Since the item is custom fabricated, there is no residual value as it cannot be used on another patient.

Thus all costs associated with providing the device can be billed to the carrier.

Do NOT use the KX modifier. Because that would indicate that you possess all documentation which is in accordance with the medical necessity guidelines of the carrier (including fitting, adjustment, etc.).

Instead you will need to send an electronic narrative (the field is different for every software so ask your vendor) or a paper narrative explaining the issues and providing your costs.

Costs include everything from the 15 minutes of monthly rent of your office it took to take the patient in, scan/cast them, etc. costs of shipping, water, heat, cost of the device, cost of paper and postage sending them notificaitons, etc.

If you are inventive enough, the bill you send to the carrier should almost approximate what you would be submitting if you actually dispensed the device.

Last, your patient should sign a contract with you at the time you cast/scan them, notifying them that you will bill the carrier for the device, after a specific period of time, say thirty calendar days (that should be part of your office policy), as "Custom Device Cancelled by Patient". Let them know failure to comply may result in them failing to be able to obtain future similar benefits based on the carrier's frequency rules.

As stated from the beginning, this is more about practice management and providing the patient with education from the onsent. Not rushing them into a decision, which may result in failure to comply is exactly what you want to avoid.

I this case, where the patient does not respond to any contact, you will need to determine the DOS. This is why a contract between you and the patient is so important. If they do not respond and you have proof you contacted them and they have not responded withint that time frame, (e.g 30 days) you can use that date as the DOS.

For more information on the Custom Fabricated Items Cancelled by Patient see:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf

See page 10 (20.3) 20.3 - Artificial Limbs, Braces, and Other Custom Made Items Ordered But Not Furnished (Rev. 1, 10-01-03

This does not apply to OTS pre-fabricated items as they can be re sold to another individual or returned to the vendor (even if you have return costs). As there is a residual value, Medicare and others will not cover these if not dispensed.