We have resolved an outstanding claim issue with 32BJ that had resulted in numerous member orthotic claims being denied. Empire BCBS functions as the agent for 32BJ handling the processing and adjudication of claims from our members.
Historically, claims for orthotics for 32BJ members were being denied as not a covered benefit. In discussions with 32BJ they agreed that certain diagnostic codes were medically appropriate so that their members could benefit from the use of orthotics. They have notified Empire BCBS to include these diagnostic codes in their claims systems. Claims for orthotics that include these Dx codes will be reimbursed effective 10/1/2015.
The codes are below using ICD-10 nomenclature (and the prior ICD-9 codes).
M722 (728.71)
M7730, M7731, M7732 (726.73)
M2020, M2021, M2022 (735.2)
Q72811, Q72812, Q72813, Q72819, Q72891, Q72892, Q72893, Q72899 (755.30)
M2010, M2011, M2012 (735.0)