Insurance Coverage
One of the most common questions we get: “will insurance companies cover our splints and what codes do I use?”. Yes, insurance companies do cover our splints but it depends on many variables. We have seen 100% coverage, partial and no coverage. We do not bill insurances so the first step is to contact your provider and check what process you need to follow to get your splints covered. The provider may be willing to reimburse you, or splints may need to be ordered through the measuring facility/orthotics company/durable medical equipment supplier (DME).
During the process you may get a question about what “L” codes or “HCPCS” codes to use for SIRIS™ splints. Most people use the static finger splint codes. The following codes can be a good starting point in the discussion with your provider. These codes do not guarantee coverage or payment and do not replace your medical providers billing expertise. It is your responsibility to bill within the appropriate billing codes for the services and or products provided. Based on feedback from individuals, our best advice is: Do not give up easily.
Since some people need multiple splints for each hand or finger a more robust “Letter of Medical Necessity (PDF)” can be important. The form we provide is a generic letter to help the therapist, doctor or yourself in the process of submitting to an insurance provider. It already includes the most common codes we see used for our splints. We suggest printing out and taking to any appointment in case it can help.
Most forms have a field labeled Place of Service. Place of Service refers to the place where you will be using the device/orthosis/splint, not where you were measured. We recommend filling in this field with the numerical code for Home. We have seen code – 12 used for Home. Please understand this information is second hand and it is your responsibility to check how to fill out any forms you are submitting.
The “click here” link, at the end of each line, takes you to a page for an exact definition and allows you to search by state to check “Fee Schedules”.
Custom Orthosis:
“L3933” – Custom fabricated finger orthosis (click here)
“L3913” – Custom fabricated hand finger orthosis
**Note: we have seen this code used for thumb splints** (click here)
“L3808” – Custom fabricated wrist hand finger orthosis
**Note: we have seen this code used for thumb splints** (click here)
“L3999” – Upper Limb Orthosis, Not otherwise specified
**Note: Does not seem to have set fee schedule, can be billed higher, may need modifier added(OR01, OR02, R03) and/or PAR (prior authorization required)** (click here)
“E1399” – Durable medical equipment, miscellaneous (click here)
**Note: Code may only be valid if ordering through DME supplier. Not all facilities have a DME classification.
Other Splint Codes:
“Q4049” – Finger splint, static (click here)
“L3927” – Prefabricated finger orthosis (click here)
“L3923” – Prefabricated hand finger orthosis (click here)
Diagnosis Codes for EDS:
The following codes are not L codes, product codes or procedural codes for SilverRing Splints. They are diagnosis codes for Ehler-Danlos syndrome.
Q79.60 Ehlers-Danlos syndrome, unspecified
Q79.61 Classical Ehler-Danlos syndrome
Q79.62 Hypermobile Ehler-Danlos syndrome
Q79.63 Vascular Ehler-Danlos syndrome
Q79.69 Other Ehler-Danlos syndrome
M62.81 Muscle weakness
M79.644 Pain in right finger(s)
M79.645 Pain in left finger(s)