AOPA Keeps Tabs on CMS

AOPA routinely scrutinizes code and reimbursement information released by the Centers for Medicare and Medicaid Services (CMS), and in doing so, has identified and resolved several recent discrepancies on behalf of the O&P profession.

AOPA contacted CMS officials in late December 2005 to resolve an error on the 2006 CMS fee schedule for code L0637. AOPA experts determined that the reimbursement range for this code was much lower than in previous years and was therefore incorrect. By early January, the reimbursement amount for code L0637 was restored to a range of $844.13 to $1,125.50—formerly at $60.35 to $80.46.

Also in December 2005, AOPA experts determined that three upper-limb replacement socket codes were missing from the Skilled Nursing Facility (SNF) Payment Plan A: L6883, L6884 and L6885.

When AOPA recognized this inconsistency, AOPA reimbursement expert Virginia Torsch approached CMS to determine whether this was an error or if the omission was intended. AOPA staff experts diligently continue to follow up with CMS officials in search of a resolution to this problem.

In addition, AOPA found that the revised 2006 fee schedule included an increase in the reimbursement amount for code L2005. The new range is from $2,947.73 to $3,930.31—formerly $2,588.80 to $3,451.73. According to CMS officials, this increase better represents the reimbursement amount for a full knee-ankle-foot orthosis, including the joint component.

AOPA also continues to contact CMS about the fact that reimbursement rates for seven codes new in 2005 and the rates for most of the new 2006 codes have yet to be released. While at press time no timeframe has been set for the release of these fees, AOPA staff members are determinedly seeking a response from CMS about this issue.

Breaking news on coding and reimbursement is available through www.AOPAnet.org and the members-only, biweekly newsletter, AOPA In Advance.