Retired - Hand Finger Orthoses (L3923) - Use of CG Modifier
Elastic garments do not meet the statutory definition of a brace. Code L3923 (Hand finger orthosis, without joints, prefabricated) includes both elastic and non-elastic items.
Elastic garments may be made of a variety of materials, including but not limited to neoprene or spandex (elastane, Lycra™). They are considered to be elastic even if they have flexible plastic or metal stays. If a garment made with elastic material has a rigid plastic or metal component, it is considered a non-elastic orthosis for purposes of coverage and coding.
If a hand-finger garment is made primarily of elastic material, it must be billed with code A4466 (Garment, belt, sleeve or other covering elastic or similar stretchable material, any type, each) and not code L3923. Claims billed with code A4466 will be denied as non-covered, no benefit category. Effective for claims with dates of service on or after July 1, 2010, if an L3923 orthosis has a rigid plastic or metal component, the supplier must add the CG modifier (policy criteria applied) to the code. Claims for L3923 billed without a CG modifier will be rejected as incorrect coding.
All products that are currently listed as code L3923 in the DMECS Product Classification List on the Pricing, Data Analysis, and Coding (PDAC) contractor web site will be end-dated June 30, 2010. Manufacturers must resubmit a new Coding Verification Review request to the PDAC if they want their product to be listed in DMECS for dates of service on or after July 1, 2010.
Suppliers should contact the PDAC with questions concerning the correct coding of these items.
|Published on PDAC website