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L3260 Heel Wedge Shoe


Question

Our Rehab wants the L3260 order for a pt patient-- I’m thinking this might be something the patient should acquire from a DME - would this be a covered item under Medicare or insurance delivered from the outpatient Physical Therapy department?

Answer

L3260 describes a surgical boot/shoe.  This code has a status indicator of "E" indicating that it is a noncovered supply on an outpatient claim.  If this code assignment is correct, you should obtain an ABN when this supply is issued to a Medicare patient.   This code assignment is questioned if you are trying to capture a Heel Wedge as L3340 or L3350 may be more accurate code options.  If one of these codes is assigned, it would be considered an covered orthotic and could be charged with one of these codes under revenue code 274.  Orthotics can be charged separately by hospitals under current Medicare guidelines.  A heel wedge does not fall into the category of DME.

Disclaimer: All articles intended for general consumption only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
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