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Linda Collins Blogger

What Codes to Use When Billing for Repairs

Posted by Linda Collins | August 02, 2016

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

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. This information needs to be present on the claim and in the medical record documentation. For the claim, the explanation of repair is entered in Item 19 on the HCFA 1500 or its electronic equivalent.

Cost of parts

L4210 REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS

L7510 REPAIR OF PROSTHETIC DEVICE, REPAIR OR REPLACE MINOR PARTS

When billing these codes, you must give a detailed description of the part being replaced. If available, include the manufacturer name, model/serial number and product name of each item. You enter this information in Item 19 of the HCFA or its electronic equivalent.

A few other reminders:

  • 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
  • The LCDs do not place a limit on the units billed for repairs. However, your notes must detail the time and materials used in the repairs.

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. Additional information about billing DMEPOS repairs can be found in the Medicare Supplier Manual. You may access this manual from your DME MAC Jurisdiction website.

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