Customized vs. Off The Shelf Codes

Why do the braces you purchase have two codes on the sticker and which one should you be using?

In January 2014, Medicare assigned a SECOND code to many types of braces. Over the following months, commercial carriers as well as Workers Comp and PI followed suit and picked up the new codes.

The original code for many of these braces became a “customized code” and the second (newer) code was added as an “off the shelf code (OTS).” So which code should you bill with?

In using the customized code, one would have to be certain that they have customized the brace for the patient. If the brace was not customized, then the Off The Shelf (OTS) code would be the correct billing code for the item.

More often than not, you would be correct in billing the OFF THE SHELF code.

Here is what the Policy States:
OTS Codes: L0648, L0650, L1851
OTS orthotics are those orthotics which require minimal self-adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit to the individual.  CMS regulations define the term “minimal self-adjustment” to mean an adjustment that the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and that does not require the services of a certified orthotist (that is, an individual who is certified by the American Board for Certification in Orthotics and Prosthetics, Inc., or by the Board for Orthotist/Prosthetist Certification) or an individual who has specialized training in the provision of customized orthosis.

Azon Medical is here to assist you in remaining compliant with your DME.

If you feel you may not be using a correct code, have any further questions on billing or coding your DME products, or need to place an order– contact your Azon DME representative.

For assistance with your bracing program or to place an order, contact us at Azon Medical:
contact: Jodi Dastur
(727) 273-7080
training@AzonMedical.com