The Goodbye Crutches Blog

What is the insurance code for a Knee Walker?

Posted by Tom Schwab

Roll-aboutThere are 2 codes your insurance company will request when you submit for reimbursement of your purchased or rented knee scooter (also known as a Knee Walker or by many brand names)

 

The first code is for the device.

HCPCS E0118: Crutch substitute, lower leg platform, with or with out wheels, each.

This generic code is applicable for all Knee Scooter regardless of brand  (Roller-aid, Free Spirit, Kneal Knee Cruiser, ROLL-A-BOUT ®, Turning Leg Caddy, Roller Foot, Drive Nee Bop, Weil, etc.)

So What is a HCPCS Code?

HCPCS Codes, often pronounce “Hics Pics” is the  Healthcare Common Procedure Coding System.  It is a system of numbers and codes used by Medicare and monitored by CMS, the Centers for Medicare and Medicaid Services. Most all private insurance companies use this same coding system

Your doctor uses Level I HCPCS Codes for procedures or services.  For example 99214 may be used for a physical. Check any recent bill and you will see everything billed has an associated HCPCs Code

Regardless if you purchase or rent a Knee Walker it is a Level II HCPCS codes that are used by medical suppliers other than physicians, such as ambulance services or durable medical equipment. These are typically not costs that get passed through a physician's office so they must be dealt with by Medicare or Medicaid differently from the way a health insurance company would deal with them.

The second code is for the procedure code?

In addition to the HCPC code your insurance company will most likely ask for your CPT Code.  The Current Procedural Technology codes developed by the American Medical Association tells them what procedure was performed.  For example 77.56 is the surgical repair of a hammer toe.

You need BOTH a CPT and a HCPCS Code

To determine benefits your insurance provider will look at both what the device is (A Knee Scooter) and what procedure made it a necessity (A Bunionectomy).  If either of the codes is incorrect it could cause an automatic denial.  For example, if Knee Scooters are covered benefit they wouldn’t be for a Rhinoplasty (nose job).

You MUST get CPT code from the doctor’s office

Sure you could go onto Google right now and search for the CPT code for what you think was done, yet it's probably quicker to call your doctor’s office directly.  It is a common question, and a request that the nurse or billing department should easily be able to obtain form your chart or bill.  Often the doctor can use qualifiers they may use.  If you submit a CPT code different from your doctor both your claim for your knee scooter along with the physician’s claim and the hospital / surgery center claim could be delayed.

 

Learn more about Knee Walkers including tips for getting your insurance provider to cover it,

Get the Free Knee Walker's Buyer's Guide

 

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Topics: FAQ, insurance, Knee Walker

   
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