Reminder: Orthotics and Prosthetics Providers Must Include Modifier for Appropriate HCPCS Codes Effective Sept. 1, 2022, codes submitted without modifier LT (left), or RT (right) will be denied
Orthotics and Prosthetics providers are reminded to use applicable modifiers when submitting claims for HCPCS codes covered in clinical coverage policy 5B, Orthotics & Prosthetics. Effective Sept. 1, 2022, Orthotics and Prosthetics HCPCS codes submitted without modifier LT (left), or RT (right) will be denied with EOB code 01619 (“The LT or RT modifier must be billed with procedure code billed. Add the appropriate modifier and resubmit the claim.”).
This guidance applies only to items that can be used for one side of the body or the other, but not for codes that are bilateral (e.g., L2640 “addition to lower extremity, pelvic control, band and belt, bilateral”) or describe a pair (e.g., L0980 “peroneal straps, pair”).
The Orthotics and Prosthetics fee schedule and full text of Orthotics and Prosthetics Clinical Coverage Policy 5B are available at North Carolina Medicaid’s Orthotic and Prosthetic Devices webpage. All COVID-19 Special Bulletins are available here.
NC Medicaid Contact Center, 888-245-0179
NCTracks Contact Center, 800-688-6696, or NCTracksProvider@nctracks.com