Information for Referring Physicians
Thank you for trusting Miller Prosthetics & Orthotics to care for your patients. We are committed to providing excellent prosthetic and orthotic care while making the referral process as straightforward as possible for you and your staff.
How to refer a patient
Send us your prescription: Fax your written order and patient information to (888) 972-5171
What we need:
Prescription with relevant medical diagnosis
Orders for prosthetic or orthotic intervention
Physician notes with specific diagnosis codes explaining why a prosthesis or custom orthosis is necessary
Not sure what the patient needs? Call us at (740) 421-4211. We are happy to discuss the patient's medical condition and therapy goals with you or your staff to determine the best course of treatment.
What Happens Next
Once we receive your referral, here is our process:
We schedule the patient for an initial evaluation
We verify insurance and seek authorization if needed
We create a detailed prescription and fax it to you for signature
Once we receive your signed prescription and complete insurance verification, we deliver the device and bill the insurance company directly.
Documentation Requirements
To help ensure insurance approval, please include the following in your notes:
Mention that you "wrote an order" We can help with the detailed prescription after our evaluation.
For custom bracing, use the word "custom" and provide the reason:
Foot/ankle needs to be controlled in more than one plane
Expected length of need is longer than 6 months
Needed for anatomical issues where shape is abnormal and cannot be fit with a standard-sized brace
⚠️ Important: "Pain" alone is not a sufficient diagnosis for orthotics. Please provide more specific diagnosis codes.
Documentation Guides
Medicare's "Same or Similar" Policy
Medicare has expanded its "Same or Similar" device policy, which limits the number of braces a patient can receive within a certain timeframe (usually five years). This policy now affects all types of braces.
What this means for your practice: If you bill Medicare for an off-the-shelf brace, Medicare will deny coverage for custom bracing for the same condition or diagnosis. You can no longer bill for a device to "hold patients over" while waiting for custom bracing.
Affected devices include:
Lace-up or wrap-around ankle supports
Walking boots
Off-the-shelf AFOs
Wrist braces, back braces, neck braces, knee braces
When you can still prescribe custom bracing:
After determining off-the-shelf bracing is not supportive enough
When off-the-shelf bracing no longer meets the patient's needs because a deformity has become multiplanar
If the patient has had a change from their original condition (weight gain, newly discovered fracture, etc.)
After trying off-the-shelf bracing and finding it insufficient
Required documentation: Medicare requires an in-person visit and documentation showing why the change from off-the-shelf to custom bracing is necessary. At minimum, your notes should indicate that off-the-shelf bracing was tried but found to be insufficient. We are happy to help clarify the insufficiency through an addendum to your notes.
Need more information? View the Same or Similar Chart and Same or Similar Denials on Noridian's website, or contact us to arrange an in-person meeting to discuss how we can help you navigate these requirements.