I’m looking to get some guidance, my provider an Orthopedic doctor normally performs application of splint/brace/orthosis at the office when seeing the patients. I am aware that we cannot bill for the application CPT code unless the splint/brace/orthosis is custom made and in the event the splint/brace/orthosis is an off-the-shelf item we should be billing for the HCPCS code instead in addition to the E/M code. I’m having a big dilemma because most of these items are off-the-shelf supplied by a third party company who bill for those separately therefore, my provider can’t bill for the HCPCS code, neither can she bill for the application because the items are off-the-shelf. My provider doesn’t feel this is right and we would like to know what else can she bill for in addition to the E/M code? I mean, she is applying the splint/brace/orthrosis himself and that takes time.

Any type of guidance will be kindly appreciated.