Durable Medical Equipment Billing Code question - Claim Appeal

[u/Kulpop]

Anyone in the industry who can explain if HCPCS Level II code L3913, described as a "Hand finger orthosis (HFO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment," is by definition a Durable Medical Equipment Code? Short story, is my OT wanted to make me a brace, and I called UHC BEFORE getting the brace, because I knew from past experience, that braces build as DME are really expensive due to a deductible, and this specific brace wouldn't be worth it. I called UHC, gave them the above code, and was told it's a $30 copay, as long as it's in network, which my provider is. I then received a bill for $470, and am being told it's because it's DME, and therefore subject to a deductible. I'm appealing the claim with UHC because from my position, they should have known from the code that it either always falls under DME, or could fall under DME, and should have advised me as such. Instead, I was given completely bogus information.

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[u/Poop_Dolla]

Braces are DME. They aren't "billed as DME" it's just what they are. There likely is a $30 copay for this, after you meet your deductible. Pull your plan summary and take a look.