CFO CFO Insurance & Billing

Question 1

Which HCPCS code category is primarily used to bill for custom-fabricated foot orthotics?

Accepted Answer

L-codes

Answer

A-codes

Answer

E-codes

Answer

K-codes

Question 2

A Certificate of Medical Necessity (CMN) for orthotics must be signed by which provider?

Accepted Answer

The ordering physician

Answer

The certified fitter

Answer

The patient

Answer

The insurance adjuster

Question 3

What does the term 'prior authorization' mean in the context of orthotic billing?

Accepted Answer

Insurance approval obtained before providing the orthotic device

Answer

Approval obtained after service is rendered

Answer

A second fitting session approval

Answer

A refund request form

Question 4

Under Medicare, what documentation is required in a patient's chart to support billing for a custom ankle-foot orthosis (AFO)?

Accepted Answer

Detailed written order, diagnosis, and clinical notes justifying medical necessity

Answer

Patient's verbal confirmation

Answer

Insurance card copy only

Answer

A photograph of the device

Question 5

Which modifier is commonly appended to an HCPCS code to indicate that a custom orthosis was fabricated from a cast or scan of the patient's limb?

Accepted Answer

Modifier KX

Answer

Modifier KE

Answer

Modifier RT

Answer

Modifier LT

Question 6

What is a Local Coverage Determination (LCD) in the context of orthotic reimbursement?

Accepted Answer

A Medicare Administrative Contractor policy defining coverage criteria for specific items

Answer

A state law governing fitter licensing

Answer

A patient consent form

Answer

A billing software module