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June 2018

Clarification: Orthopedic footwear, therapeutic shoes are limited to 1 pair per year

In the March 2017 edition of The Record, we provided the following information related to submitting claims for orthopedic footwear and therapeutic shoes:

  • Updated billing rules
  • Quantity and frequency guidelines

We’ve received feedback indicating that there is confusion about the quantities we listed in the article. To clairify, the quantity/unit of “two per year” means that we’ll cover one pair of two items per year.

A pair can be defined as:

  • One item for the left foot and one item for the right foot
  • Two items for the left foot
  • Two items for the right foot

Any combination of items is limited to a quantity/unit of two and one pair per year.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
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