By Kim Turner, RN, Clinical Consultant
The HCPCS L3960 is defined as a prefabricated shoulder "airplane design" abduction orthosis which includes the elbow wrist hand and fingers. There are adjustable rigid cuffs and joints/components to optimize the shoulder, elbow, wrist and hand angles. Shoulder position is capable of 90 degrees abduction from torso. Adjustable rigid chest and pelvic frames or panels supports shoulder and arm components. Product is all-inclusive of soft interface and closures/straps. It is used for abducting the arm away from the body and capable of immobilizing the shoulder, elbow, wrist, and hand.
The DME MACs are reporting a substantial increase in claim submission for HCPCS code L3960. In response, the coding guidelines will be revised. Effective for claims with dates of service on or after August 1, 2020 the only products which may be billed using the code L3960 are those for which a written coding verification review has been made by the Pricing, Data Analysis, and Coding (PDAC) contractor and subsequently published on the appropriate Product Classification list."
To ensure timely processing of your Medicare claim for HCPCS L3960 and to ensure proper Medicare coverage and payment of the product billed, please check the DMEC PDAC product classification list “prior to billing”to confirm the product to be billed has been reviewed and code verified by the PDAC with the HCPCS L3960.
If you need assistance with PDAC coding submissions or have questions related to this post, contact us today!