CFO CFO Insurance & Billing 2

Question 1

When billing Medicare for a prefabricated orthosis that requires fitting, which HCPCS code modifier indicates the item was off-the-shelf?

Accepted Answer

Modifier NU

Answer

Modifier NU indicates a new item is being purchased, while off-the-shelf prefabricated orthotics are billed using codes that reflect no custom fitting was performed.

Question 2

A claim for an orthotic device is denied due to a 'missing modifier.' What is the most appropriate first step?

Accepted Answer

File a corrected claim with the appropriate modifier attached

Answer

When a claim is denied for a missing modifier, the correct action is to file a corrected claim (CMS-1500 with 'corrected' indicated) including the required modifier.

Question 3

Which ICD-10 code category is most commonly used to justify orthotic fitting for a patient with diabetic peripheral neuropathy?

Accepted Answer

E11.40 (Type 2 diabetes with diabetic neuropathy)

Answer

E11.40 (Type 2 diabetes mellitus with diabetic neuropathy, unspecified) is the primary diagnosis code used to support medical necessity for diabetic foot orthotics.

Question 4

What is the typical timely filing limit for Medicare Part B orthotic claims?

Accepted Answer

1 year from date of service

Answer

Medicare Part B requires claims to be submitted within 1 year (12 months) from the date of service to be considered for payment.

Question 5

Under the Therapeutic Shoe Bill (Medicare Part B), how many pairs of custom-molded inserts is a qualifying diabetic patient entitled to per calendar year?

Accepted Answer

Three pairs

Answer

Under Medicare's Therapeutic Shoe Benefit, qualifying diabetic patients may receive up to three pairs of custom-molded inserts per calendar year.

(CFO) Certified Fitter Orthotics Practice Test

(CFO) Certified Fitter Orthotics Practice Test

CFO CFO Insurance & Billing 2