BMAD Data – Statistical Analysis of the Services We ... · David J. Freedman, DPM, CPC, CPMA . 1 . BMAD Data – Statistical Analysis of the Services We Provide and Why You . Should

David J. Freedman, DPM, CPC, CPMA

1

BMAD Data – Statistical Analysis of the Services We Provide and Why You Should Care

David J. Freedman, DPM, FASPS, CPC, CPMA ● APMA Coding Committee Chair, member

and advisor since 2005 ● Board Member, US Foot and Ankle

Specialists and Vice-President Foot and Ankle Specialists of the Mid-Atlantic of the Mid-Atlantic (FASMA)

● Certified Professional coder (CPC) ● Certified Professional Medical Auditor

(CPMA) ● Compliance Auditor ● Codingline Expert ● Past Chairperson, 9th and 10th Annual

National APMA CAC PIAC meeting ● CAC member Maryland ● 32+ years of Coding Experience

Disclaimer CPT codes and their descriptions and the policies discussed in this webinar do not

reflect or guarantee coverage or payment. Just because a CPT code exists, payment for the service it describes is not guaranteed. Coverage and payment policies of

governmental and private payers vary from time to time and for different areas of the country. Questions regarding coverage and payment by a payer should be directed to

that payer. The coding advice here reflects only the opinions of the speaker. APMA and the speaker do not claim responsibility for any consequences or liability attributable to

the use of the information contained in this presentation

Reference Current Procedural Terminology (CPT®) is copyright 1966,

1970, 1973, 1977, 1981, 1983-2020 by the American Medical Association. All rights reserved. CPT is

a registered trademark of the American Medical Association (AMA). Reference 2020 CPT

Professional

2019 BMAD PRESENTATION OF PART B MEDICARE RELEVANT STATISTICAL DATA FROM 2018

4

CERT, should there be concern?

1) Total Part B allowed charges for 2018 was $143.4 billion dollars compared to $139.1 Billion in 2017. 2) $80 million Increase in podiatric allowed charges, compared to 2017 which had a 10 million increase previously. 3) Podiatrists represented $2.27 billion or 1.6 percent and this represents the same % as was in 2017. 4) The top 300 procedures/services accounted for 92.7% in 2018 down from 92.8% in 2017 of podiatric Medicare allowed charges.

Source: https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Downloads/AB-Jurisdiction-Map-Jun-2019.pdf

• Noridian JE Exp 10/2020–CA, HI, NV, American Samoa, Guam, Northern Mariana Islands & JF Exp 7/2025–AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY = 16

• Novitas JL Exp 8/2021– DC, DE, MD, NJ, PA, N.VA & JH Exp 5/2026– AR, CO, LA, MS, NM, OK, TX ) and First Coast JN – Exp 2/2022 FL, PR, US Virgin Islands =16

• NGS -J6 (JG)Exp 5/2020 – IL, MN, WI and JK Exp 1/2022– CT,NY,MA, ME, NH, RI,VT =11

• Palmetto GBA JM(J11) Exp 10/2022 – NC, SC,VA, WV and JJ AL, GA, TN Exp 9/2022 = 7

• WPS -J5 (JG) Awarded on 9/20/19 – IA, KS, MO, Ne and Exp is TBD? and J8 Exp 2025 IN,MI –6

• CGS J15 (JI) Exp 8/2023 KY, OH =2 Source: https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-

Administrative-Contractors/MedicareAdministrativeContractors.html

A/B MAC AWARDS CONSOLIDATION

RUC EFFECT Total Part B

($billions) all allowed charges % increase

Total Part B Allowed

DPMs ($billions) % increase

DPM % of Total Allowed

2010 122.9 5 2.03 7 1.70 2011 126.7 3 2.13 5 1.70 2012 128.1 1 2.17 2 1.70 2013 128.0 (>-1) 2.21 2 1.70 2014 129.2 1 2.18 -1 1.70 2015 132.9 3 2.16 -1 1.62 2016 135.4 2 2.18 1 1.61 2017 138.1 2 2.19 <1 1.59 2018 143.4 ~4 2.27 ~4 1.60

In 2016 and subsequently the Coding Committee began to recommend all to report four new HCPCS modifiers to define specific subsets of modifier 59: XE Separate Encounter, a service that is distinct because it occurred during a Separate encounter; XS Separate Structure, a service that is distinct because it was performed on a separate organ/structure; XP Separate Practitioner, a service that is distinct because it was performed by a different practitioner; and XU Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service.

Continued Reporting in 2018

This spreadsheet represents ALL Providers

Table 12B: 2018 Medicare Part B, Top 250 Services Utilizing Modifier for Distinct Procedural Service ALL providers (Distinct procedural service modifiers : 59, XE, XS, XP, XU)

0 0 0 0 0 0 0 0 00 0 0 0 0 Avg Alwd Chrg Sub Freq Alwd Freq

Alw Chg 0 0 Allowed Submitted Allowed Alwd per 1000 per 1000 per 1000Rank HCPCS Short Descriptor Charges Frequency Frequency Chrg Benes Benes Benes

1 97530 Therapeutic activities $238,538,973 6,747,378 6,222,853 $38 $7,503 212 1962 11100 Biopsy skin lesion $162,549,818 1,955,606 1,888,288 $86 $5,113 62 593 11721 Debride nail 6 or more $112,413,035 2,683,029 2,462,264 $46 $3,536 84 774 97140 Manual therapy 1/> regions $71,193,534 3,884,746 3,116,654 $23 $2,239 122 985 97110 Therapeutic exercises $65,928,291 2,812,584 2,501,394 $26 $2,074 88 796 63650 Implant neuroelectrodes $55,030,065 24,916 21,683 ##### $1,731 1 17 45380 Colonoscopy and biopsy $45,766,006 514,913 493,621 $93 $1,439 16 168 17000 Destruct premalg lesion $40,572,057 1,147,735 1,103,933 $37 $1,276 36 359 11720 Debride nail 1-5 $38,865,472 1,250,765 1,164,300 $33 $1,222 39 37

10 97112 Neuromuscular reeducation $38,045,959 1,413,313 1,197,980 $32 $1,197 44 3811 88341 Immunohisto antb addl slide $35,975,993 1,079,926 881,868 $41 $1,132 34 2812 96372 Ther/proph/diag inj sc/im $34,573,571 1,843,459 1,703,922 $20 $1,087 58 5413 88305 Tissue exam by pathologist $32,961,407 742,872 688,200 $48 $1,037 23 2214 17110 Destruct b9 lesion 1-14 $28,003,147 287,977 269,729 $104 $881 9 815 93458 L hrt artery/ventricle angio $27,589,259 170,797 158,786 $174 $868 5 516 97164 Pt re-eval est plan care $27,545,465 520,662 473,805 $58 $866 16 1517 93306 Tte w/doppler complete $25,160,897 175,452 164,936 $153 $791 6 518 88342 Immunohisto antb 1st stain $23,911,773 474,429 410,538 $58 $752 15 1319 43239 Egd biopsy single/multiple $22,770,737 323,216 309,438 $74 $716 10 1020 81408 Mopath procedure level 9 $22,245,350 15,352 11,135 ##### $700 0 021 93000 Electrocardiogram complete $20,440,776 1,261,735 1,179,310 $17 $643 40 3722 11056 Trim skin lesions 2 to 4 $20,416,157 402,832 363,267 $56 $642 13 1123 17311 Mohs 1 stage h/n/hf/g $19,861,378 42,830 39,607 $501 $625 1 124 97116 Gait training therapy $19,128,877 854,319 776,248 $25 $602 27 2425 22845 Insert spine fixation device $18,773,466 40,753 36,629 $513 $590 1 1

Table 12A: 2018 Medicare Part B, Top 50 Services Utilizing Modifier for Distinct Procedural Service Podiatry (Distinct procedural service modifiers : 59, XE, XS, XP, XU)

Table 12A: 2018 Medicare Part B, TOP 50* Services Utilizing Modifier for Distinct Procedural ServiceData for Podiatry Listed by Ascending HCPCS

*(Top 50 services ranking based on 2018 allowed charges for podiatry claims utilizing modifier for distinct procedural service.)(Beneficiary source: CMS 2018 Medicare Enrollment Statistics. DPM count source: APMA database, August 2018)

Avg Alwd Chrg Sub Freq Alwd Freq

Alw Chg Allowed Submitted Allowed Alwd per 1000 per 1000 per 1000 Alwd Chrg Sub Freq Alwd FreqRank HCPCS Short Descriptor Charges Frequency Frequency Chrg Benes Benes Benes per DPM per DPM per DPM

1 11721 Debride nail 6 or more $111,436,414 2,652,679 2,436,127 $46 $3,505 83 77 $6,185 147 1352 11720 Debride nail 1-5 $38,530,068 1,235,849 1,151,728 $33 $1,212 39 36 $2,139 69 643 11056 Trim skin lesions 2 to 4 $20,289,964 398,923 360,237 $56 $638 13 11 $1,126 22 204 G0127 Trim nail(s) $11,745,523 694,751 642,663 $18 $369 22 20 $652 39 365 11042 Deb subq tissue 20 sq cm/< $7,858,407 99,482 85,654 $92 $247 3 3 $436 6 56 97597 Rmvl devital tis 20 cm/< $7,549,433 108,438 95,613 $79 $237 3 3 $419 6 57 11055 Trim skin lesion $7,232,823 181,063 157,337 $46 $227 6 5 $401 10 98 28285 Repair of hammertoe $5,794,610 28,206 24,626 $235 $182 1 1 $322 2 19 11730 Removal of nail plate $4,813,614 59,878 50,801 $95 $151 2 2 $267 3 310 11057 Trim skin lesions over 4 $4,527,447 80,566 73,097 $62 $142 3 2 $251 4 411 11750 Removal of nail bed $3,258,622 28,807 25,968 $125 $102 1 1 $181 2 112 11719 Trim nail(s) any number $3,039,683 349,244 323,984 $9 $96 11 10 $169 19 1813 11755 Biopsy nail unit $2,467,037 23,588 21,235 $116 $78 1 1 $137 1 114 17110 Destruct b9 lesion 1-14 $2,400,158 25,016 22,363 $107 $75 1 1 $133 1 115 11765 Excision of nail fold toe $2,280,468 17,595 15,849 $144 $72 1 0 $127 1 116 10060 Drainage of skin abscess $2,279,188 23,193 19,828 $115 $72 1 1 $127 1 117 28270 Release of foot contracture $2,248,913 12,524 10,689 $210 $71 0 0 $125 1 118 11043 Deb musc/fascia 20 sq cm/< $2,161,582 14,927 12,506 $173 $68 0 0 $120 1 119 20550 Inj tendon sheath/ligament $2,019,611 50,421 44,001 $46 $64 2 1 $112 3 220 29580 Application of paste boot $1,890,481 46,715 37,810 $50 $59 1 1 $105 3 221 29581 Apply multlay comprs lwr leg $1,866,776 39,657 35,161 $53 $59 1 1 $104 2 222 11305 Shave skin lesion 0.5 cm/< $1,809,131 24,647 23,016 $79 $57 1 1 $100 1 123 29540 Strapping of ankle and/or ft $1,586,611 100,323 76,146 $21 $50 3 2 $88 6 424 64450 N block other peripheral $1,244,502 37,932 22,084 $56 $39 1 1 $69 2 125 11306 Shave skin lesion 0.6-1.0 cm $1,237,935 13,075 12,310 $101 $39 0 0 $69 1 1

(Distinct procedural service modifiers: 59, XE, XS, XP, XU)

This spreadsheet represents JUST Podiatry

• Bunionectomy Data 2018 • Podiatry Vs Ortho

2018 Other Surgery • Podiatry vs Ortho

Look at the NGS website when you log in to this Medicare Contractor Site, one of the “Top LCD’s” is Routine foot care from 2018 through today. So why should we care?

Table 1: 2018 Medicare Part B, Top 50* DPM Services and then the Top CPT Code Allowed Nationally #1 vs #2

2018 E&M “NEW” ALL

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All Physicians Podiatry Ortho Gen Surg Derm Gen/Fam/Int Other Phys

Table 5I: 2018 Medicare Part B, Top 300* DPM Services

99201 99202 99203 99204 99205

2018 E&M “ESTABLISHED” ALL Podiatry Allowed Frequency 2018

9921199212992139921499215

Gen Surg Allowed Frequency 2018

9921199212992139921499215

Ortho Allowed Frequency 2018

9921199212992139921499215

Derm Allowed Frequency 2018

9921199212992139921499215

• 99212 ranking remained 5th • 99213 ranking remained 1st • 99214 ranking has changed to 12th

from 13th • 99203 ranked again 3rd • 99202 dropped from 12th to 17th

ranked

2018 Podiatric E&M ranking changes compared to 2017:

Table 3A: 2018 Medicare Part B, Top 300* DPM Services Data for Podiatry Listed by Descending HCPCS

*(top 300 ranking based on 2018 allowed charges for podiatry specialty category)

Chg Allowed % of Submitted Allowed % of Avg % Freq

Rank HCPCS APMA Short Descriptor Charges Alw Chg Frequency Frequency Alw Frq Alw Chg Assgn

Total Top 300 codes $2,107,507,052 100.0% 36,515,097 33,472,748 100.0% $63 0.0% 1 99213 Office/outpatient visit, estab, level 3 $365,587,612 999.8% 5,307,534 5,024,603 319.9% $73 0.0% 2 11721 Nail debridement, any method, 6+ $311,393,996 851.6% 7,547,530 6,956,904 443.0% $45 0.0% 3 99203 Office/outpatient visit, new, level 3 $136,279,958 372.7% 1,387,630 1,276,319 81.3% $107 0.0% 4 11056 Paring/cutting benign hyperkeratotic les, 2-4 $119,719,674 327.4% 2,225,557 2,033,882 129.5% $59 0.0% 5 99212 Office/outpatient visit, estab, level 2 $75,399,792 206.2% 1,811,305 1,720,333 109.5% $44 0.0% 6 11042 Debridement, skin & subcut tissue $73,530,154 201.1% 813,902 739,259 47.1% $99 0.0% 7 11720 Nail debridement, any method, 1-5 $68,354,406 186.9% 2,242,443 2,072,747 132.0% $33 0.0% 8 Q4131 Skin substitute, Epifix, per sq cm $53,719,946 146.9% 362,534 333,395 21.2% $161 0.0% 9 11055 Paring/cutting benign hyperkeratotic les, 1 $42,113,117 115.2% 998,577 892,710 56.8% $47 0.0%

10 97597 Remove devit tiss, w/o anes <20 sqcm $39,732,358 108.7% 570,732 514,857 32.8% $77 0.0% 11 11730 Nail avulsion, partial/total, single $39,611,594 108.3% 427,946 387,332 24.7% $102 0.0% 12 99214 Office/outpatient visit, estab, level 4 $33,865,311 92.6% 347,514 323,613 20.6% $105 0.0% 13 73630 Xray, minimum 3 views foot $27,954,771 76.4% 1,047,889 979,512 62.4% $29 0.0% 14 11750 Perm removal nail, partial/total $25,951,291 71.0% 200,874 188,560 12.0% $138 0.0% 15 11057 Paring/cutting benign hyperkeratotic les, 4+ $23,305,425 63.7% 385,512 351,572 22.4% $66 0.0% 16 17110 Destruct any method warts up to 15 $21,665,024 59.2% 210,814 195,082 12.4% $111 0.0% 17 99202 Office/outpatient visit, new, level 2 $21,439,318 58.6% 315,627 291,012 18.5% $74 0.0% 18 99308 Nursing facility, subseq, per day, level 2 $21,287,751 58.2% 330,990 300,943 19.2% $71 0.0% 19 Q4159 Affinity, per sq cm $20,476,889 56.0% 38,118 34,581 2.2% $592 0.0% 20 G0127 Trim nail(s) $18,316,325 50.1% 1,098,733 1,000,472 63.7% $18 0.0%

Modifier 25 by Specialty but which E&M-25 Was Most Frequent?

•Table 3A High End E&M

Table 5A compares common 10 CPT’s with other specialties

• Ulcer Codes What is different with 2018?

• Table 9A shows top states payment %

• Table 9A showing the bottom states 89% worst

Major Improvement in % claims paid is this good?

• Wyoming scored best at 96% • New Mexico and Indiana while still doing a great number scored

lowest 89% of clean claims was considered the lowest 2 states for claims being paid.

• Next were Missouri, Alabama, Vermont, Nebraska, Minnesota, Georgia, Kansas, and North Carolina scored 90% paid claims

• 2018 revealed the best podiatry claims processing 93% • Is something wrong when more than 7% of claims are not

approved? (CERT Rate was 10.68%) • Total PART B % was paid at 82.6% in 2017 but improved to 93% in

2018- This was the benchmark and podiatry is all above that mark except half states/jurisdictions. Overall better than 2017 all states.

Example #1 • 11720 $33(Up $1 from-2017) + 11719

$11(same as 2017) = $44 (National average 2018 we see a $1 increase)

Example #2 • 11720 $33 + G0127 $18 (Up $2 from-

2017) = $51 (National average 2018)

RFC Combo coding help or hurt you financially in 2018?; 11721 Vs. 11720+11719 or 11720+G0127 ? 11721 $45 (National average went up $1 from)

% of Tot % of Tot Avg Allowed Part B Submitted Allowed Part B Alwd

Charges Alw Chg Frequency Frequency Alw Frq Chrg DPMsTotal Part B $2,124,809,631 100.0% 41,464,209 34,070,682 100.0% $62 18,016Top 50 Services $1,808,805,562 85.1% 32,324,064 29,827,136 87.5% $61 18,016California $231,361,931 10.9% 3,717,109 3,471,231 10.2% $67 2,072New York $180,501,674 8.5% 3,096,484 2,816,570 8.3% $64 2,046Florida $173,309,541 8.2% 2,835,253 2,692,144 7.9% $64 1,431Pennsylvania $106,531,722 5.0% 2,212,706 2,048,315 6.0% $52 1,220Texas $92,197,855 4.3% 1,555,672 1,411,055 4.1% $65 990Illinois $97,603,448 4.6% 1,738,671 1,590,983 4.7% $61 979New Jersey $118,522,511 5.6% 2,157,491 1,993,274 5.9% $59 973Ohio $64,799,250 3.0% 1,304,256 1,224,176 3.6% $53 841Michigan $69,827,796 3.3% 1,246,230 1,145,186 3.4% $61 745Massachusetts $46,874,368 2.2% 906,381 841,275 2.5% $56 398Georgia $34,769,364 1.6% 624,862 561,651 1.6% $62 383Virginia $32,066,913 1.5% 556,383 516,708 1.5% $62 382Maryland $34,257,389 1.6% 663,543 612,624 1.8% $56 378

ary source: CMS 2018 Medicare Enrollment Statistics (non-HMO). DPM count source: APMA database, Augu

Table 9A: 2018 Medicare Part B, Top 50* DPM Services by State*(Top 50 DPM services - ranking based on 2017 allow ed charges for podiatry specialty category)

Table 9A: 2018 Medicare Part B, Top 50* DPM Services by State *(Top 50 DPM services - ranking based on 2017 allowed charges for podiatry specialty category)

(Beneficiary source: CMS 2018 Medicare Enrollment Statistics (non-HMO). DPM count source: APMA database, August 2018.)

% of

Tot % of

Tot Avg

Allowed Part B Submitted Allowed Part B Alwd Part B Enrolle

es

Charges Alw Chg Frequency Frequency

Alw Frq Chrg Enrollees DPMs

Per DPM

Total Part B $2,124,809,631 100.0% 41,464,209 34,070,682 100.0% $62 31,793,581 18,016 100% Top 50 Services $1,808,805,562 85.1% 32,324,064 29,827,136 87.5% $61 31,793,581 18,016 92 Mississippi $12,134,063 0.6% 180,182 166,268 0.5% $73 433,373 71 610385 Wyoming $1,796,304 0.1% 33,101 31,706 0.1% $57 92,387 16 577419 Arkansas $8,699,815 0.4% 163,336 151,300 0.4% $58 416,985 81 514796 South Carolina $21,716,057 1.0% 405,347 378,315 1.1% $57 667,669 139 480337 Oklahoma $15,973,422 0.8% 228,309 211,456 0.6% $76 507,117 108 469553 Vermont $1,502,516 0.1% 31,403 28,394 0.1% $53 114,799 26 441535 Kansas $11,378,878 0.5% 242,780 218,075 0.6% $52 384,731 89 432282 Alabama $13,805,396 0.6% 255,683 231,266 0.7% $60 526,348 135 389887 West Virginia $7,249,026 0.3% 149,062 137,342 0.4% $53 258,588 67 385952 Alaska $1,641,667 0.1% 20,659 19,340 0.1% $85 82,359 23 358083 New Hampshire $5,147,287 0.2% 100,926 94,065 0.3% $55 217,590 61 356705 North Carolina $33,239,249 1.6% 616,016 553,016 1.6% $60 1,100,045 320 343764

1) 2012 had peak-downward trend in $ of DPM services 2) Upward trend in total allowed charges since 2015 3) 2018 Medicare enrollees decreased (- Advantage) 4) Ave dollars per service increased to $66.83

2018 28800 28805 28810 28820 28825 TOTAL719 6247 6783 18,254 8016 40019

2017 28800 28805 28810 28820 28825 TOTAL698 5503 6034 21,188 8723 42146

2016 28800 28805 28810 28820 28825 TOTAL757 5623 8592 19,540 9197 43709

2015 28800 28805 28810 28820 28825 TOTAL538 4065 5490 13,538 6104 29735

2014 28800 28805 28810 28820 28825 TOTAL693 5037 7288 17,064 8366 38448

2013 28800 28805 28810 28820 28825 TOTAL675 4361 6987 15,954 7751 35728

Table 13A: Medicare Part B Trend: Amputations are on the rise. Compare the Top CPT Amputation Codes Submitted

Frequency 2013-2018

https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/31346_6/l31346_neuro005_cbg_010112.pdf

Where did podiatry perform the services in 2018?

• 2018 ASC TOP 10 Procedures • Based On Allowed Frequency

2018 TOP ICD-10 Data from large group practice

2019 DME BMAD PRESENTATION OF PART B MEDICARE RELEVANT STATISTICAL DATA FROM 2018

1) Total allowed charges for 2018 Medicare Part B, Top 300* DME and HCPCS Level II Codes $139,479,983 2) The submitted frequency by podiatrists was 3,615,022 but Allowed Frequency was 3,242, 051. This means 90% of claims were allowed or paid in 2018. This compares to reviews by the 2 Carriers and CERT that shows 35.54% errors substantially higher than this rate, one must be concerned! 3) Podiatrists average allowed DME charge was $43.

2018 DME Update

A. Specialty Contractors • National Supplier Clearinghouse (NSC) • Pricing, Data Analysis and Coding Contractor (PDAC) • DME Common Electronic Data Interchange (CEDI) B. DME MAC’s • CGS • Noridian

• LINK: https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-

Administrative-Contractors/Who-are-the-MACs

DME/MAC Contractors

https://www.palmettogba.com/nsc

PDAC is run by Palmetto GBA became effective 1/15/2019

Source: https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Downloads/DME-Jurisdiction-Map-Jun-2019.pdf

This spreadsheet represents JUST Podiatry TOP 30 DME

Table 14B: 2018 Medicare Part B, Top 300* DME and HCPCS Level II Codes Data for Podiatry Listed by Descending Allowed Charges

*(top 300 ranking based on 2018 allowed charges for podiatry speciatly category)

Chg Allowed % of Submitted Allowed % of Avg % Freq

Rank HCPCS APMA Short Descriptor Charges Alw Chg Frequency Frequency Alw Frq Alw Chg Assgn

Total Top 300 codes $139,479,983 100.0% 3,615,022 3,242,051 100.0% $43 100.0%

1 A5500 Diab shoe for density insert $23,287,911 16.7% 356,919 326,315 10.1% $71 100.0%

2 A5512 Multi den insert direct form $15,201,380 10.9% 569,294 521,962 16.1% $29 100.0%

3 A5513 Multi den insert custom mold $12,949,755 9.3% 325,117 298,659 9.2% $43 100.0%

4 A6010 Collagen based wound filler $10,857,615 7.8% 343,145 311,873 9.6% $35 100.0%

5 L4361 Pneuma/vac walk boot pre ots $10,185,089 7.3% 43,356 37,604 1.2% $271 100.0%

6 L1940 Afo molded to patient plasti $6,966,016 5.0% 15,942 13,919 0.4% $500 100.0%

7 L4360 Pneumat walking boot pre cst $6,160,090 4.4% 27,386 23,331 0.7% $264 99.8%

8 L2330 Lacer molded to patient mode $5,965,958 4.3% 17,028 15,254 0.5% $391 100.0%

9 L3000 Ft insert ucb berkeley shell $5,544,195 4.0% 60,030 19,776 0.6% $280 99.1%

10 L1970 Afo plastic molded w/ankle j $4,492,884 3.2% 7,513 6,292 0.2% $714 100.0%

11 L1971 Afo w/ankle joint, prefab $3,534,745 2.5% 9,295 7,938 0.2% $445 100.0%

12 L4396 Static or dynami afo pre cst $2,809,627 2.0% 21,084 17,554 0.5% $160 100.0%

13 L1902 Afo ankle gauntlet pre ots $2,782,977 2.0% 41,192 34,493 1.1% $81 100.0%

14 L4397 Static or dynami afo pre ots $2,746,705 2.0% 19,600 17,149 0.5% $160 100.0%

15 A6021 Collagen dressing <=16 sq in $2,158,413 1.5% 100,544 91,606 2.8% $24 100.0%

16 L2820 Soft interface below knee se $1,841,575 1.3% 24,590 21,436 0.7% $86 100.0%

17 L5000 Sho insert w arch toe filler $1,702,239 1.2% 3,624 3,215 0.1% $529 100.0%

18 L1906 Afo multilig ank sup pre ots $1,170,522 0.8% 12,361 10,041 0.3% $117 99.9%

19 A6023 Collagen dressing >48 sq in $1,132,208 0.8% 5,655 5,286 0.2% $214 100.0%

20 L1930 Afo plastic $1,106,755 0.8% 5,352 4,670 0.1% $237 99.7%

21 L1907 Afo supramalleolar custom $1,057,401 0.8% 2,224 1,977 0.1% $535 100.0%

22 L3020 Foot longitud/metatarsal sup $988,035 0.7% 10,026 5,344 0.2% $185 99.4%

23 A6212 Foam drg <=16 sq in w/border $961,576 0.7% 100,382 88,521 2.7% $11 100.0%

24 K0005 Ultralightweight wheelchair $870,175 0.6% 523 428 0.0% $2,033 100.0%

25 L2280 Molded inner boot $654,044 0.5% 1,706 1,383 0.0% $473 100.0%

26 L4386 Non-pneum walk boot pre cst $640,781 0.5% 5,019 4,248 0.1% $151 99.9%

27 A6222 Gauze <=16 in no w/sal w/o b $506,732 0.4% 229,804 211,404 6.5% $2 100.0%

28 L0650 Lso sc r ant/pos pnl pre ots $497,255 0.4% 668 430 0.0% $1,156 100.0%

29 L4387 Non-pneum walk boot pre ots $463,052 0.3% 3,625 3,150 0.1% $147 100.0%

30 L1960 Afo pos solid ank plastic mo $426,406 0.3% 964 750 0.0% $569 100.0%

• Let’s look at the top 15 for 2018 1 A5500 Diab shoe for density insert $23,287,911 16.7% 356,919 326,315 10.1% $71 100.0%

2 A5512 Multi den insert direct form $15,201,380 10.9% 569,294 521,962 16.1% $29 100.0%

3 A5513 Multi den insert custom mold $12,949,755 9.3% 325,117 298,659 9.2% $43 100.0%

4 A6010 Collagen based wound filler $10,857,615 7.8% 343,145 311,873 9.6% $35 100.0%

5 L4361 Pneuma/vac walk boot pre ots $10,185,089 7.3% 43,356 37,604 1.2% $271 100.0%

6 L1940 Afo molded to patient plasti $6,966,016 5.0% 15,942 13,919 0.4% $500 100.0%

7 L4360 Pneumat walking boot pre cst $6,160,090 4.4% 27,386 23,331 0.7% $264 99.8%

8 L2330 Lacer molded to patient mode $5,965,958 4.3% 17,028 15,254 0.5% $391 100.0%

9 L3000 Ft insert ucb berkeley shell $5,544,195 4.0% 60,030 19,776 0.6% $280 99.1%

10 L1970 Afo plastic molded w/ankle j $4,492,884 3.2% 7,513 6,292 0.2% $714 100.0%

11 L1971 Afo w/ankle joint, prefab $3,534,745 2.5% 9,295 7,938 0.2% $445 100.0%

12 L4396 Static or dynami afo pre cst $2,809,627 2.0% 21,084 17,554 0.5% $160 100.0%

13 L1902 Afo ankle gauntlet pre ots $2,782,977 2.0% 41,192 34,493 1.1% $81 100.0%

14 L4397 Static or dynami afo pre ots $2,746,705 2.0% 19,600 17,149 0.5% $160 100.0%

15 A6021 Collagen dressing <=16 sq in $2,158,413 1.5% 100,544 91,606 2.8% $24 100.0%

Let’s look at the top 16-30 for 2018 16 L2820 Soft interface below knee se $1,841,575 1.3% 24,590 21,436 0.7% $86 100.0%

17 L5000 Sho insert w arch toe filler $1,702,239 1.2% 3,624 3,215 0.1% $529 100.0%

18 L1906 Afo multilig ank sup pre ots $1,170,522 0.8% 12,361 10,041 0.3% $117 99.9%

19 A6023 Collagen dressing >48 sq in $1,132,208 0.8% 5,655 5,286 0.2% $214 100.0%

20 L1930 Afo plastic $1,106,755 0.8% 5,352 4,670 0.1% $237 99.7%

21 L1907 Afo supramalleolar custom $1,057,401 0.8% 2,224 1,977 0.1% $535 100.0%

22 L3020 Foot longitud/metatarsal sup $988,035 0.7% 10,026 5,344 0.2% $185 99.4%

23 A6212 Foam drg <=16 sq in w/border $961,576 0.7% 100,382 88,521 2.7% $11 100.0%

24 K0005 Ultralightweight wheelchair $870,175 0.6% 523 428 0.0% $2,033 100.0%

25 L2280 Molded inner boot $654,044 0.5% 1,706 1,383 0.0% $473 100.0%

26 L4386 Non-pneum walk boot pre cst $640,781 0.5% 5,019 4,248 0.1% $151 99.9%

27 A6222 Gauze <=16 in no w/sal w/o b $506,732 0.4% 229,804 211,404 6.5% $2 100.0%

28 L0650 Lso sc r ant/pos pnl pre ots $497,255 0.4% 668 430 0.0% $1,156 100.0%

29 L4387 Non-pneum walk boot pre ots $463,052 0.3% 3,625 3,150 0.1% $147 100.0%

30 L1960 Afo pos solid ank plastic mo $426,406 0.3% 964 750 0.0% $569 100.0%

2018 Podiatric DME Bottom 30 276 A6442 Conform band n/s w<3"/yd $1,092 0.0% 6,189 6,064 0.2% $0.18 1556.3% 277 L5850 Endo ak/hip knee extens assi $1,072 0.0% 9 8 0.0% $134 1502533.3% 278 E0303 Hosp bed hvy dty xtra wide $1,043 0.0% 6 6 0.0% $174 30700.0% 279 L3674 So airplane w/wo joint cf $1,019 0.0% 1 1 0.0% $1,019 10038200.0% 280 L8430 Prosthetic sock multi ply ak $1,014 0.0% 54 42 0.0% $24 14200.0% 281 L3420 Full sole/heel wedge btween $1,013 0.0% 34 27 0.0% $38 47476.5% 282 L0460 Tlso 2 shl symphys-stern cst $950 0.0% 1 1 0.0% $950 24100.0% 283 L3080 Arch supp att to shoe metata $899 0.0% 50 46 0.0% $20 1120.0% 284 A6453 Self-adher band w <3"/yd $898 0.0% 1,329 1,283 0.0% $1 925.2% 285 L5925 Above knee manual lock $866 0.0% 2 2 0.0% $433 2103150.0% 286 L2830 Soft interface above knee se $856 0.0% 27 9 0.0% $95 20944.4% 287 L8417 Pros sheath/sock w gel cushn $837 0.0% 14 13 0.0% $64 3507.1% 288 L3340 Shoe wedge sach $822 0.0% 11 10 0.0% $82 914036.4% 289 L3350 Shoe heel wedge $819 0.0% 43 37 0.0% $22 8600.0% 290 L3070 Arch suprt att to sho longit $795 0.0% 32 29 0.0% $27 1072296.9% 291 L8440 Shrinker below knee $769 0.0% 18 18 0.0% $43 1806205.6% 292 L5654 Socket insert symes $762 0.0% 3 2 0.0% $381 18975666.7% 293 L6686 Suction socket $761 0.0% 1 1 0.0% $761 9600.0% 294 L6692 Silicone gel insert or equal $730 0.0% 2 2 0.0% $365 80350.0% 295 A6448 Lt compres band <3"/yd $710 0.0% 893 546 0.0% $1 39967.6% 296 L6625 Rotation wrst w/ cable lock $686 0.0% 1 1 0.0% $686 41900.0% 297 A6237 Hydrocolld drg <=16 in w/bdr $686 0.0% 90 80 0.0% $8.57 198022.2% 298 A6232 Hydrogel dsg>16<=48 sq in $672 0.0% 179 87 0.0% $7.72 67361.5% 299 L3510 Orthopedic shoe add rub insl $666 0.0% 44 24 0.0% $28 238.6% 300 L0626 Lo sag rig pnl stays pre cst $664 0.0% 10 9 0.0% $74 1050.0%

Let’s look at the top 50 DME ALL Providers for 2018 #3 Code should Podiatry prescribe Lumbo Sacral Orthoses?

Let’s look at the top 50 DME ALL Providers for 2018 #4 Code-Knee Orthotic

Let’s look at the top 50 DME ALL Providers for 2018 #10 Code

Let’s look at the top 50 DME ALL Providers for 2018 #11 Code

Let’s look at the top 50 DME ALL Providers for 2018 #20 Code

Let’s look at the top 50 DME ALL Providers for 2018 #21 Code

Let’s look at the top 50 DME ALL Providers for 2018 #23 Code

Let’s look at the top 50 DME ALL Providers for 2018 #24 Code

Let’s look at the top 50 DME ALL Providers for 2018 #31 Code

Top 50 DME ALL Providers for 2018 #32 Code

Top 50 DME ALL Providers for 2018 #34 Code

Top 50 DME ALL Providers for 2018 #44 Code

Top 50 DME ALL Providers for 2018 #45 Code

Top 50 DME ALL Providers for 2018 #48 Code

Table 14F: 2018 Medicare Part B, Diabetic Shoe DME Codes

Data by HCPCS by Specialty

Table 14F: 2018 Medicare Part B, Diabetic Shoe DME Codes

Data by HCPCS by Specialty

Table 14F: 2018 Medicare Part B, Diabetic Shoe DME Codes

Data by HCPCS by Specialty

Table 14F: 2018 Medicare Part B, Diabetic Shoe DME Codes

Data by HCPCS by Specialty

Table 14A: 2018 Medicare Part B, Top 300* DME and HCPCS Level II Codes

Data for Podiatry Listed by Ascending HCPCS

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