Are You Seeing Claim Rejections? This Could Be Why
Proactive Preparation for Same or Similar
Where and How to Properly Store Personal Employee Information
Who Signed This Prescription?
Ins and Outs of TRICARE
What is an ABN and How To Use It?
A How to Guide for Navigating RAC Audits for Medical Practices
How To Choose a New Hampshire Medical Billing Company
5 Ways Your Medical Practice Can Reduce Billing Errors and Increase Cash Flow
Commonly Seen Incorrect Reasons for Appeal
Incorrect Reasons for Appeals for L5940 & L5950
One of the most common appeals we receive is for the L5940 or L5950. Usually the denial is due to the claim being split and separating the L5940 or L5950 from the Medicare approved endoskeletal system or socket. However, there are situations when the claim cannot be appealed. Prior to appealing the claim, the following two factors need to be reviewed:
Is the claim billed with a Medicare approved endoskeletal system or socket HCPCS code?
CMS published Transmittal 1630 on November 7, 2008 that reads “Contractors shall allow payment for HCPCS code L5940 only when the claim is billed with one of the following endoskeletal system or socket HCPCS codes: L5301, L5311, L5321, L5531, L5341, L5700, L5701, L5702 or L5703.” If none of the approved HCPCS codes appear on the claim, then your claim has denied correctly and cannot be appealed.
Is the claim being billed with knee/shin system, pylon, ankle, foot, etc.?
The Local Coverage Determination states “Codes L5940-L5960 for ultra-light materials may only be used when materials such as carbon fiber, fiberglass, Kevlar®, or other advanced composite lamination materials are used in the fabrication of a socket for an endoskeletal prosthesis. They are not used for ultralight materials used in other components of a prosthesis – e.g., knee/shin system, pylon, ankle, foot, etc. For codes L5940-L5960, the unit of service is per limb.”
There are cases you can bill a claim that will have both a knee/shin system, pylon, ankle, or foot and an endoskeletal system. When this occurs, you want to make sure the prosthetist’s notes indicate what the L5940 or L5950 was used in conjunction with, either the endoskeleton system or socket.
Have more questions? Contact us through our contact us form!
“We have been using CBS Billing for almost a year now, and I cannot express how thankful we are for their wonderful service. Since we opened our doors, they have... „
“The quality and service we receive from CBS is amazing! Every step of the process is made easier because the CBS team is extremely knowledgeable, very attentive... „
“CBS has been wonderful to our company. Honestly, I don’t know how I have functioned this long without them. CBS has been an asset to my claims, and I can’t than... „
“Our company discovered CBS after hiring two other billing companies who fell desperately short of our high standards and expectations. In today's third party... „
“The folks at CBS have provided detailed statements on a timely basis, kept our billing process very organized, and are a pleasure to work with. „
“CBS is a true partner in our success. „
“They are the right people for the job. They are the future of O&P, today! „
“It’s been a pleasure to work with CBS over the last 5 years. „