How to Bill a Claim with a Miscellaneous code (L2999 or L5999)

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.

The miscellaneous HCPCS codes include:

• L2999 – lower extremity orthosis, NOS (not otherwise specified)
• L5999- lower extremity prosthesis, NOS (not otherwise specified)

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 should specify how miscellaneous codes are processed. Payers may use one of the following methods for determining reimbursement of miscellaneous codes:

1. Percent of Billed Charges
2. MSRP Minus
3. Invoice Plus

Percent of Billed Charges

The contract may state "payment will be X% of billed charges." The payer will discount the amount you submit on the claim by the percentage indicated in the contract. In this case, you must be aware of the percentage so you can determine your reimbursement. If your contract is not clear, contact the Provider Relations department at the payer. 

MSRP Minus

The contract may state "payment will be MSRP minus X%." The claim may be held for payment until you provide the MSRP amount. The payer may ask for official documentation to substantiate the MSRP. In this case, you may use the Össur MSRP letter specific to the product.

The contract may state "payment will be the invoice amount plus X%." In this case, the payer will ask for a complete invoice and increase it up by the amount specified in the contract.

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. The manufacturer may provide a description to you or you may choose to write your own narrative. There is limited character space, which means you may need to use abbreviations.
• 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)

What does this mean for you?

The use of miscellaneous codes may be valid as a way to describe certain products. Be prepared with the information, complete the form with the requested descriptions, plan on an inquiry from the payer, and understand the reimbursement methodology used to pay miscellaneous codes.