[serina.breen@comcast.net]

What modifiers should be used when billing for HCPCS L0627 & L0731 & L0737? These are for Spinal Orthoses (Back Braces).

[Cuda]

Here is the link to CMS's LCD Policy, navigate to LCD ID L11448, click on the LCD ID number to read the policy & guidelines.

http://www.cms.hhs.gov/mcd/results_i...=25&page_num=2

[iharrison]

We have billed L0637 several times. Never used a modifier used with this code. FYI- make sure you have documentation from the physician that the patient has tried other methods to resolve their back pain prior to the brace being dispensed. We have started to get a few pre-payment audits asking for this.

[serina.breen@comcast.net]

Good to know! What is considered acceptable "other methods" to have tried
and failed before a back brace L0637 is an acceptable option?

Best Regards,
Serina Breen
Freedom Mobility Center
586 Parker Ave - Rodeo, CA 94572
Tel 510.799.9920
Fax 510.280.0778
Serina.Breen@comcast.net

[iharrison]

Basically, Medicare is wanting us to show if they tried any medication or physical/occupational therapy to address their back issues. But that's just our experience

[Bethany]

I was getting denials on my L0627 to Medicare. I took all modifiers out and submitted with absolutely no modifiers..no NU, no KX...nothing...so far Medicare has paid on one. Try this.

[btrevolution4]

Yes, with back braces, you use NO modifiers. I've billed for L0631 and L0637's all the time and always get paid, just make sure you have the Rx and all medical records to support the brace being issued to the patient. See LCD for further details.

[Bethany]

I had trouble with Medicare denying L0627. I submitted without any modifiers and they paid...go figure?????