orthotic overhaul

Dr. Freedman is correct with respect to Fed BCBS. It is also possibly true for other primary insurance carriers who do cover orthotics. But if one reads the original question, this was for a Medicare patient.

For insurance's other than Medicare, which do cover foot orthotics, the overhaul and repairs may be covered. It would be wise to contact the carrier prior to performing such services and inquire regarding their coverage for repairs on existing orthotics. By the way: Be aware that an overhaul is a type of repair.

You are correct in that it would be crazy for Medicare to pay for an overhaul of a foot orthotic when they don't cover the orthotic itself. And for that reason, Medicare does not cover the overhaul or anything related to the foot orthotic, unless that orthotic is placed into a shoe which is an integral part of a leg brace.

Thus the answer to your question is almost universally NO!

This seemingly innocent question and answer is actually an answer to a much broader subject. That is, coding and reimbursement are not identical.

Just because a code exists (e.g. UCB Type foot orthotic L3000) does not mean that there is reimbursement.

This exists not only in the DME world but in medicine as well.

Is routine foot care covered for every patient? No However, there are many codes which are part of the routine foot care spectrum. The coverage for those codes are based on a long winded policy.