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Linda Collins Blogger

Billing Repairs

Posted by Linda Collins | March 16, 2017

Your patient returns with an orthotic or prosthetic device that needs repair. The manufacturer’s warranty no longer covers the product. How do you get paid for your time and materials? When an orthosis or prosthesis has to be repaired, and is no longer under warranty, there are specific labor and parts codes you can use.

Cost of labor:

  • L4205 REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES
  • L7520 REPAIR PROSTHETIC DEVICE, LABOR COMPONENT, PER 15 MINUTES

Cost of parts:

  • L4210 REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS
  • L7510 REPAIR OF PROSTHETIC DEVICE, REPAIR OR REPLACE MINOR PARTS

These codes are billed in 15- minute increments for actual time involved in repairs. (If the repair is required within the applicable warranty period for the device, it is considered to be included in the initial cost of the device.) If the labor time involved in the repair is 30 minutes, you will bill 2 units of the code.

When billing one of the repair codes, you must explain what you are repairing and provide a narrative description of the base items. You should also document how long the repairs took. For the claim, the explanation of repair is entered in Item 19 on the HCFA 1500 or its electronic equivalent. Provide sufficient explanation of the time and repairs.

The box 19 field is limited to 71 characters so it is necessary to be concise and use abbreviations. For example, “rpl hng tghn stp 15m” may be used to describe replacing a hinge and tightening a strap which took 15 minutes of time. Medicare does not offer suggested abbreviations but suggest suppliers be creative in their descriptions.

The LCDs do not place a limit on the units billed for repairs.

There may be unpublished Medically Unlikely Edits (MUE) in place. This means the Medicare claims processing software may automatically deny the claim after a certain amount of units are billed. If this happens, and you have sufficient documentation to support your repair time, you can request a reconsideration of the denied claim. Be sure, your notes detail the time and materials used in the repairs.

A few other reminders:

  • This information needs to be present on the claim and in the medical record documentation
  • Repairs are typically covered to make the device serviceable
  • A new physician’s order is not needed for repairs
  • Use RT or LT modifiers on the HCPCS to identify the device
  • Repairs are not paid on devices previously denied by Medicare

What does this mean for you?

You can provide necessary repairs for your patients and bill for time and materials. Be sure to appropriately document the time involved, the details of the repair, and the specific parts used. 

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