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L4361 Service Type Codes to Send

HCPCS code

Orthotics (braces and supports)

CMS description

Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf

Why these codes

5010 has no orthotics code; payers answer braces under DME, some under prosthetic devices.

If a payer returns nothing

Payers don't all answer every service type. Send 30 (Health Benefit Plan Coverage) for the plan's general benefits.

Sources

CMS HCPCS Level II descriptor; X12 HIPAA 5010 service type code definitions; VerifyTX billing practice

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