Billing Miscellaneous Codes
When the existing HCPCS do not adequately describe a product, you have the option to use a miscellaneous code. There are specific requirements to include in your claim when using a miscellaneous code.
HCPCS Codes
- L2999 – Lower extremity orthosis, NOS (not otherwise specified)
- L5999 – Lower extremity prosthesis, NOS (not otherwise specified)
- L7499 – Upper extremity prosthesis, NOS (not otherwise specified)
Claim Form
On the claim form, either HCFA 1500 or electronic equivalent, you must include specific information in certain boxes:
- Box 19 requires a description of the product, including manufacturer name, product name and model, price.
- Box 21 requires a diagnosis code. This will be an ICD 10 code provided by the prescribing physician.
- Box 24D requires you to list the miscellaneous code you are billing (e.g. L2999)
- SV101-7 Segment requires a concise description of the product. Limited to 80 characters
Reimbursement
Miscellaneous codes do not have specific reimbursement amounts. Payers have various methods for determining payment amount when a miscellaneous code is submitted. Private payer contracts usually specify how miscellaneous codes are processed and they generally use one of the following methods:
- __% of Billed Charges
- MSRP minus __%
- Invoice plus __%
What Does This Mean for You?
Review your payer contracts and understand how each payer manages payment of miscellaneous codes. This is particularly important to know prior to requesting pre-authorization of a product. The pre-authorization department does not have access to payer contracts and will not be able to give you an idea of payment. Understanding the method for determining payment on miscellaneous codes helps you determine how and when to bill.