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David McGill Blogger

Important Medicare Billing Info for 2013

Posted by David McGill | January 02, 2013

​Welcome to 2013 and the first day of Medicare paying claims according to its new fee schedule. Here are the 2 things you need to know about Medicare payments as of today.

1. If one is the loneliest number …

...then what is .8? It's the percentage increase in what Medicare pays for L codes in 2013 v. last year.

2. Ossur's POWER KNEE has a new code!

Starting today, Medicare will process claims using L5859 to describe the unique features offered by POWER KNEE. There are two things you need to understand when billing for POWER KNEE.

First, when creating L5859 for POWER KNEE, Medicare expressly stated that this new code should be used in conjunction with four other already-existing L codes: L5856; L5828; L5845; and L5848. In other words, Medicare has approved the use of all 5 of these codes when billing POWER KNEE.

Second, if you download the 2013 DMEPOS Fee Schedule and look up L5859, you will see a fee of $0.00. But this does not mean that Medicare refuses to reimburse L5859! All it means is that until Medicare decides on a fee, the supplier must select an appropriate amount for L5859. Medicare will review all claims submitted to it between now and April and then set a final fee schedule amount for this new code. Medicare has explicitly stated that L5859 will be updated with a fee effective July 1, 2013.

If you have any questions about appropriately billing L5859, please contact an Össur sales representative or customer service.

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