1. Brenda Taylor
   Posted 4 months ago #
   

   I billed Cigna for orthotics (L3020 and L3020-50) and they are only paying for 1. I spoke w/them and they dont want modifier 50 or LT and RT. Help please. These are the only modifiers I have every used for this HCPCS code and looking through my hcpcs modifiers I am lost.

2. SuperCoder
   Posted 3 months ago #
   

   It seems that you have denial of code L3020 due to missing modifiers. If that is the case, I will suggest as follows:
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   When billing for a shoe that is an integral part of a leg brace or for related modifications, inserts, heel/sole replacements or shoe transfer, a KX modifier must be added to the code. If the shoe or related item is not an integral part of a leg brace, the KX modifier must not be used.
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   If the shoe and related modifications, inserts, and heel/sole replacements are not an integral part of a brace, the GY modifier must be added to each code.
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   If a KX or GY modifier is not included on the claim line, it will be rejected as missing information.
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   When billing for prosthetic shoes and related items, an ICD-9 diagnosis code (specific to the 5th digit), describing the condition which necessitates the prosthetic shoes, must be included on each claim for the prosthetic shoes and related items.

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