Working in Florida, non-Medicare/Medicaid, Accounts Receivable Multiproduct Lines TPA with vendor network- In order to confirm that billing was accurate and that shortpayments and denials should be appealed by collectors, I need to confirm my understanding of these features of non prosthetic L codes. Also need to confirm need for Department of HEalth professional license inclusion in billing. All help will be very much appreciated.
1. Prefabricated are the only codes for which OTS or custom fitted must be determined for appropriate coding? Codes clearly defined as OTS or Custom fabricated are self defined in the long description.
2. Codes with includes fitting and adjustment are classified as ORTHOSES: PREFABRICATED (CUSTOM FITTED) by PDAC. All of these codes require the services of a orthotist or equivalent training?
3. Addition to codes L1010 for example that do not reference custom fitting or fabrication are classified by PDAC as custom fabricated. Do these codes require the services of orthotist or person with equivalent training?
4. Code L2999 Lower extremity orthosis not otherwise specified is classified by PDAC as custom fabricated. This follows because the product and service are unusual enough to not be represented by a code. A professional is required to be associated with this code?
5. Can custom fabricated products be constructed in a geographically different location using mold, measurements, xrays, CAD\CAM and drop shipped to a patient?
Must these have final fitting by a professional?
Are custom fabricated products always built by an orthotist or someone with equivalent training?

I need to be 100% confident of my understanding of these questions in this product group. Thank you for sharing your expertise.