AOPA Fights to Overturn Coding Proposal

AOPA participated in a July meeting set up by Orthomerica at Centers for Medicare and Medicaid Services (CMS) headquarters in Baltimore to help resolve a coding issue concerning new HCPCS (Healthcare Common Procedure Coding System) code applications related to protective and cranial remolding orthoses.

At public meetings held in April 2006, CMS proposed changes to the codes used to describe protective helmets (L0100 and L0110) and cranial remolding orthoses (S1040) that would have made billing for these devices more difficult. However, the proposed changes to these codes were included in the agenda for the “supplies and other” group instead of O&P and therefore no O&P representatives were in attendance at this public meeting to challenge the ruling.

Once AOPA realized the error, staff took action to protest CMS on this decision and requested a meeting to discuss protective helmets and cranial remolding orthoses. CMS agreed to a meeting with Orthomerica, which invited AOPA to attend and assist.

At the July meeting, AOPA provided background to CMS about the significant differences between protective helmets and cranial remolding orthoses and the need for the codes to be kept as they currently stand. CMS representatives expressed their appreciation for the additional information and agreed to convey the information to the full HCPCS workgroup before a final decision is issued.

The final decision on this matter will be released in October 2006 with the annual HCPCS update. Any changes will be effective Jan. 1, 2007.

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