Custom orthotics are a core part of podiatric care—but getting paid for them can be tricky. Many practices either under-bill or fail to capture revenue altogether because of unclear payer rules.
Orthotic Device Codes
- L3000 – L3030: Custom foot orthotics (each foot)
- A5513: Therapeutic diabetic inserts (custom molded)
- A5500: Diabetic shoes (per pair)
Be sure to bill per foot when applicable and include modifiers if required.
Coverage Challenges
- Medicare: Generally does not cover orthotics unless for diabetic foot disease.
- Private Insurance: Some plans cover partial cost, others exclude orthotics entirely.
- Cash Pay: Practices often set up payment plans or package pricing for patients.
Documentation Requirements
- Medical necessity must be clearly stated: pain, deformity, ulcer prevention, etc.
- Include physical exam notes and gait analysis results.
- Save the orthotic prescription and casting documentation in the patient chart.
Tips to Reduce Rejections
- Verify benefits before casting.
- Collect copays or full payment upfront for non-covered orthotics.
- Provide patients with a letter of medical necessity to submit to their insurer.
Communicating Costs to Patients
Patients appreciate transparency. Offer a printed cost breakdown and explain whether their plan covers the device or if it’s a self-pay item. This avoids confusion and improves collections.
