Procedure Codes

Effective for dates of service on or after September 22, 2003, all California-only "local" Orthotics and Prosthetics (O & P) HCPCS codes (X8100 – X9050) will be terminated. National-level HCPCS codes are available to bill for these services (L0000 – L9999). (Refer to the Medi-Cal manual for allowable national codes for O & P.) In addition, O & P consultation (code X9030) and mileage (code X9032) will no longer be Medi-Cal benefits.

Taxable Orthotic Procedures

Effective for dates of service on or after September 22, 2003, only the following orthotic codes are taxable:

• L3040 – L3100 (non-custom arch supports)
• L3201 – L3595 (orthotic footwear, modification and additions)

Modifiers

Effective for dates of service on or after September 22, 2003, California-only modifiers -Y2, -Y3, -Y7 and -Y8 will no longer be available for use with O & P appliances. These modifiers, however, will remain available for Durable Medical Equipment (DME) items and hearing aids until further notice. Modifiers -Y4 and -Y9 will continue to be available to bill for undeliverable custom-made items. National-level modifiers -LT (left side), -RT (right side) and -RP (replacement and repair) will be available for Medi-Cal billing. Modifiers -RT and/or -LT must be used with all non-spinal or cervical O & P HCPCS codes (L1500 – L8499).

Note: Modifier -RP will be for tracking purposes only. Providers must use codes L4205/L4210 and L7510/L7520 for O & P repair reimbursement.

Also effective for dates of service on or after September 22, 2003, up to three modifiers may be used per claim line. The modifiers may be used to describe unilateral, bilateral and/or a non-delivered custom item. Multiple modifiers cannot be billed via Computer Media Claims (CMC). Claims that require multiple modifiers must be submitted on a paper claim.

Partial Billing Example Using -LT/-RT Modifiers, Same Claim Line, for Bilateral Appliances

Partial Billing Example Using -LT/-RT Modifiers, Separate Claim Lines, for Right and Left Side Appliances

Partial Billing Example Using -LT/-RT/-Y4 Modifiers for Undeliverable, Custom-Fabricated, Bilateral Appliances

Manual pages reflecting these changes will be released in a future Medi-Cal Update.