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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.

Paul, You may have an opinion, but you are not an attorney. In every podiatric practice sale I have been involved im, it was ALWAYS the seller who is responsible for records of previous patients. This makes sense since it is the seller, not the buyer who actually treated the patient.

As you can imagine the re-credential process varies by payers. CMS/Medicare call it revalidation and as long as you don't let it expire your participation continues, with the recredentialing the earliest is 30 days. For Private insurance, it is a minimum of 60-90 days, but I have seen it 90-120 days or more. If a provider is currently credentialed and is in the process of recredentialing as long as the participation status has not changed, then the provider can continue billing for services while waiting on the recredentialing. If you are asking when a new practitioner bill for services, it is generally recommended to hold billing from the date the Insurance has said they received the application and started considering participation. Make sure you get it in writing that the start date will be retroactive to the date they started processing the participation status. It is recommended to request them to provide the date they will consider and only then should the provider see patients in that insurance plan.

The product I found is not Acel Micromatric but Maristem Micromatrix when doing a search and is made by Integra, their link is here: https://products.integralife.com/micromatrix-ubm-particulate/product/wound-reconstruction-care-inpatient-acute-or-micromatrix. The proper HCPCS Code is Q4118 as asked in your question. The question you need to answer what Medicare MAC are you trying to bill this in? The fact is, it is billed Matristem micromatrix, 1 mg. So, if you apply the lowest amount can order at 20mg, you bill 20 Units. As for specific guidelines in application, you must document exactly what is in the package insert to be considered for coverage.