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The insurance carriers I deal with in my area do not consider the casting code to be inclusive to the orthotics. You should check with your carriers first, to see what they have to say.

Additionally, we haven't used the 29799 code for several years now. The podiatrist I work for attended a seminar that was exclusively about orthotics and billing for them, and was told that we could use the A4580 code for casting supplies. I doublechecked with the major insurance carriers before billing that code, and they all told me it was fine to do so. I have not had a problem once with using it, and the carriers never ask me for office notes.

A few other things...if you do not use plaster for the casting, but instead use a foam impression box, you bill S0395, and make sure you use the L3000 code PER orthotic, with a LT and RT modifier appended. I have seen a lot of offices that think the L3000 code is submitted once for a pair of orthotics, when that is not the case.

Finally, if you do not do so already, it would be wise to call the patient's insurance company before doing anything orthotic related. Several major carriers exclude foot orthotics completely, no if's and's or but's.