CMS Issues Instructions for DME MACs to Immediately Implement Provisions that Require the Recognition of Orthotist and Prosthetist Clinical Documentation as Part of the Medical Record


AOPA and its lobbying team have been pressing CMS from all levels, most recently, including consultation with Trump Administration officials at the Office of Management and Budget, to formally implement the provisions of Section 50402 of the Bipartisan Budget Act of 2018 (Public Law 115-123) as it related to the prosthetist’s and orthotist’s clinical notes.  AOPA was encouraged by the DME MAC notification 2-3 weeks ago where the DME MAC Medical Directors announced that they were ‘retiring’ the August 2011 “Dear Physician” letter on Lower Limb Prosthetics.

AOPA would like to share a recent letter from Alec Alexander, CMS’ Director of Program Integrity which indicates that CMS “has issued instruction to the Durable Medical Equipment (DME) Medicare Administrative Contractors (MAC) to implement Section 50402 immediately.”

Section 50402 states:

‘‘(5) DOCUMENTATION CREATED BY

17 ORTHOTISTS AND PROSTHETISTS.—For purposes of

18 determining the reasonableness and medical neces-

19 sity of orthotics and prosthetics, documentation cre-

20 ated by an orthotist or prosthetist shall be consid-

21ered part of the individual’s medical record to sup-

22 port documentation created by eligible professionals

23 described in section 1848(k)(3)(B).’’.

Mr. Alexander’s letter is a clear assertion of CMS’ commitment to acknowledge immediate implementation of the new statutory provisions in Section 50402, accepting the orthotist and prosthetist clinical notes as part of the individual’s medical record as to “determining the reasonableness and medical necessity of orthotics and prosthetics” e.g., functional levels, identification of broken, damaged parts and their repair, and identifying components in a category included in a physician approved detailed written order.  We also suggest that AOPA members consider including a copy of the letter with all claims they file.

AOPA will continue to keep you informed of any developments in this important area.

Click here to view the letter from Mr. Alexander.

To view the DME MAC announcement of the retirement of the Dear Physician letter for lower limb prostheses, click here.