AOPA Works to Change "Useful Lifetime" for Orthoses

AOPA staff contacted the Centers for Medicare and Medicaid Services (CMS) in the spring of 2006 regarding the definition of "useful lifetime" of orthotic devices. The longstanding policy on current lifetime expectancy for all orthotic devices is five years.

AOPA staff explained to CMS that the "useful lifetime" policy for orthotic devices is a sweeping generalization about devices that are all very different. Allowing each orthotic device to have the same "useful lifetime" of five years is not reasonable.

For example, the normal wear and tear on a foam collar (L0120) would not be the same as on an ankle foot orthosis (L1940). CMS responded to AOPA’s objection by requesting that AOPA make recommendations for a more reasonable lifetime span for orthotic L codes.

As a result, the AOPA Coding Committee reviewed approximately 200 base orthotic codes and developed a new "useful lifetime" and justification for each one. For example, AOPA determined that the reasonable lifetime for a foam collar (L0120) would be six months, instead of five years.

These recommendations were submitted in late August to CMS. AOPA staff has followed up with CMS regarding the materials submitted and is working to schedule a meeting to discuss the recommendations.

AOPA is hopeful that CMS will accept the justification provided. In April 2001, CMS determined that it would no longer apply the "useful lifetime" rule for prosthetic devices, but instead pay to replace the device if there is a change in the condition of the patient or prosthetic device.

AOPA staff will continue to push CMS to reevaluate the "useful lifetime" rule in orthotics.

You can stay on top of the latest coding, billing and reimbursement changes from Medicare by reading the members-only newsletter AOPA In Advance. This newsletter is available by e-mail. Send the e-mail addresses you wish to receive this newsletter, along with your AOPA member ID and street address, to Kim Striker at kstriker@AOPAnet.org.

If you’re not an AOPA member and want to receive the AOPA In Advance newsletter, contact Kelly O’Neill at koneill@AOPAnet.org or (571) 431-0852.