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    O&P Alliance Statement on BOC

    Friday, Jan 09, 2026

    Important 2014 HCPCS Code/Competitive Bidding Update

    The Centers for Medicare and Medicaid Services (CMS) has released the 2014 HCPCS update.  This update includes all new, changed, and deleted HCPCS codes that will be implemented for claims with a date of service on or after January 1, 2014.  For codes that describe orthotic and prosthetic services, there are 24 new codes, 63 codes that have had their descriptors changed and 1 code that has been deleted.  This represents a significant number of changes in the O&P code set and represents a new reality for O&P providers specifically in relation to 23 services that have been split into two categories; orthoses that are provided “off the shelf” with no additional fitting and training, and those that are “customized to fit a specific patient by an individual with expertise.”

    The August 2013 release of CMS’ final OTS list served as a clear indication of what was to come.  In this release, CMS provided responses to AOPA’s and other organizations concerns regarding the original OTS list.  The final list contained 32 codes that would always be considered OTS and proposed the split of 23 codes into off the shelf version and custom fit versions.  The creation of the split codes essentially sets the stage for CMS to include HCPCS codes which include the term “off the shelf” in their descriptors in a future round of competitive bidding.  AOPA has voiced its serious concerns regarding CMS’ expansion of the term “off the shelf” from the statutory definition which requires “minimal self adjustment” to include adjustments provided by the “beneficiary, caregiver, or supplier” through multiple meetings and correspondence with CMS officials.  Unfortunately, as indicated by the release of the 2014 HCPCS file, AOPAs concerns continue to fall on deaf ears.  While the potential for inclusion of OTS orthoses in future rounds of competitive bidding is obviously a major concern for the O&P profession, indications to date have been that it is not imminent and may be  months or possibly years away.

    A larger concern, and one with potentially immediate impact, is how the split codes may affect O&P provider’s ability to bill and receive proper reimbursement for orthoses which require the expertise and professional training of an O&P professional in order to prevent potential harm to patients.  Essentially there are now two ways to deliver the 23 orthoses that have had their codes split; those provided without any fitting and training, and those that are customized to fit a specific patient by an individual with expertise.  The question that has now been created is who will make the decision whether an orthoses requires proper fitting by a trained individual or can be delivered as an off the shelf item without additional fitting and training?  AOPA members must be especially cognizant of the need to document the medical need for additional fitting and training as well as the actual time spent customizing the device to meet the individual needs of the patient.  The referring physician should also be encouraged to document the need for additional training and fitting as well.

    AOPA will continue to press CMS for answers to the questions above and make sure that its member’s best interests are properly represented.

    Below are links to several resources that provide additional information regarding the new and revised codes.  The November 2013 AOPA Executive Director letter, published prior to the release of the HCPCS file provides a thorough review of the potential impact of the code changes.  In addition, links to the AOPA summary of HCPCS additions, deletions, and changes, the August 2013 CMS final OTS list and comments, a letter to Laurence Wilson of CMS, and a brief overview of the potential impact of competitive bidding are included.

    • Click here for the November 2013 AOPA Executive Director Letter

    • Click here for the 2014 AOPA Code Changes Summary

    • Click here for the Letter to CMS Director Laurence Wilson

    • Click here for the Competitive Bidding Overview

    The upcoming AOPA Audio conference, scheduled for Wednesday, December 11, 2013 at 1 p.m. Eastern Time, will focus on the upcoming changes to the HCPCS codes and their potential impact on O&P providers. The cost of the call for AOPA members is just $99 for an unlimited number of participants per telephone line.

    Registration for the call may be completed online here.

    Questions regarding this issue may be directed to Joe McTernan at  jmcternan@aopanet.org  or Devon Bernard at  dbernard@aopanet.org .

    AOPA Board of Directors Begin 2013 – 2014 Term

    WASHINGTON, DC — During the American Orthotic & Prosthetic Association’s (AOPA) 2013 O&P World Congress, results of the electronic voting by members was announced. AOPA members elected new officers to its executive committee and welcomed two newly elected members to the Board of Directors.

    On December 1st, 2013 the members of the Board will begin the 2013-2014 term. The new officers and directors are:

    • Anita Liberman-Lampear, MA – President
    • Charles Dankmeyer, CPO – President Elect
    • Thomas F. Kirk, Ph.D. – Immediate-Past President
    • James Campbell, Ph.D., CO – Vice President
    • Maynard Carkhuff – Director
    • Donald Shurr, CPO, PT – Clinical At-Large Director 

    James Weber, MBA continues as Treasurer and currently serving Board members are:

    • Alfred E. Kritter, CPO, FAAOP – Director
    • Eileen Levis – Director (Re-elected to 3 year term)
    • Ronald Manganiello – Director
    • Dave McGill – Director
    • Michael Oros, CPO – Director
    • Jeff Collins, CPA – Supplier Director
    • Scott Schneider – Supplier Director

    Current AOPA President Tom Kirk, Ph.D. introduced the Board saying, “this team that has been elected by AOPA’s membership is comprised of professionals who have extensive business and clinical experience and have demonstrated their commitment to the O&P industry. I look forward to serving with this distinguished panel as we begin a year that will demand hard work confronting threats on the state- and national-level, and fighting to protect our patients and their access to quality care.”

    2013 O&P World Congress Call for Papers

    Gaylord Palms Resort, Orlando, Florida, USA – The American Orthotic and Prosthetic Association (AOPA) and its partners, The U.S. National Member Society of the International Society for Prosthetics and Orthotics (USISPO); and the German Association of Orthopaedic Technology/Con.fair.med are pleased to announce this call for papers for the 2013 World Congress to be held Sept. 18-21, 2013 at the Gaylord Palms Resort, Orlando, Florida, USA.

    The World Congress program committee has made a commitment to having a strong scientific program and is soliciting scientific and clinical case study abstracts for the congress. The committee invites you to submit an abstract to be considered for presentation at the congress.

    The committee has also made a commitment to have extraordinary plenary sessions with invited speakers who are leading experts from the world over, such as the following esteemed professionals.

    • Dr. Roy D. Bloebaum, Ph.D. – is a Research Scientist and Co-Director of the VA Bone and Joint Research Lab at the Dept of Veterans Affairs Salt Lake City Health Care System. Dr. Bloebaum’s publications include 113 peer reviewed manuscripts on bone and total joint replacement related topics and he has been a guest lecturer on these topics all over the world.
    • Heinz Trebbin, CPO, MSc – is an international activist, speaker and founder of the renowned Don Bosco P&O educational program, the only fully accredited P&O program in all of Latin America.
    • Dr. Andrew Hansen, Ph.D. – is the Director of the Minneapolis VA Rehab Engineering Research Program and Associate Professor at the University of Minnesota. Dr. Hansen is an internationally recognized expert in ankle-foot prosthetics. His team is actively developing rehabilitation technologies and performing research studies to evaluate effects of medical devices on user performance.
    • Dan Berschinski, a decorated war veteran, lost both of his legs during Operation Enduring Freedom. This has not slowed him down. He recently founded and will serve as CEO of Two-Six Industries LLC, a service-disabled veteran-owned small business. Two-Six Industries produces injection molded plastic components; new research will explore the commercial feasibility of prosthetic socket designs. He also serves on the board of directors for the Amputee Coalition.
    • Dieter Juptner – President of the German Group Ampuwiki

    Strong scientific and clinical case study submissions are expected from around the world. The format of the conference will provide a substantial audience for novel research focused on orthotics and prosthetics. The AOPA hosted World Congress will bring together prosthetists, orthotists, physicians, scientists, researchers, engineers, programmers, clinicians, and other professionals. This diverse community of professionals focusing on different aspects of orthotics and prosthetics will provide a unique and powerful environment to advance the field forward.

    Before submitting a paper we ask that you review the model for the abstract format which also provides additional information about the submission process. The model abstract is available at this link:

    Papers are being accepted for podium, poster and/or symposium sessions. Click here for more information or to submit a paper.

    For general information about the congress, we invite you  to visit the World Congress website, email worldcongress@AOPAnet.org or contact Tina Moran at (571) 431-0808.

    We look forward to seeing you in Orlando in September 2013 for the largest and most significant event for orthotics, prosthetics and pedorthics in the Western Hemisphere.

    Dobson DaVanzo Study: Medicare Scandal

    STUDY: MEDICARE SCANDAL CONTINUES WITH SIGNIFICANT PERCENTAGE OF PAYMENTS FOR ORTHOTIC AND PROSTHETIC DEVICES GOING ILLEGALLY TO UNLICENSED PROVIDERS

    CMS Payments to Unlicensed Providers Violates 2000 and 2005 Laws; Regulatory “Overkill” by Agency Adds Insult to Injury by Tying Up Legitimate Industry in Red Tape.

    WASHINGTON, D.C. September 17, 2013 – Despite laws passed by Congress in 2000 and 2005 and a 2009 “60 Minutes” expose, the Centers for Medicare & Medicaid Services (CMS) has failed to stop the illegal practice of paying unlicensed providers for orthotic and prosthetic services provided to Medicare beneficiaries, according to a new study by Allen Dobson, PhD, Dobson DaVanzo & Associates, LLC, and former director of research of the Health Care Financing Agency (currently CMS). Furthermore, CMS has incorrectly told Congress that such illegal payments have ceased and is now engaged in an overkill regulatory assault on legitimate licensed industry providers.

    According to the report, a significant percent of the $3.62 billion CMS paid between 2007-2011 for orthotic and prosthetic services for Medicare beneficiaries went to unlicensed providers, as well as those who fail to meet the accreditation requirement legislated by Congress in 2000.   This means that billions of dollars in payments were made to providers who Congress specifically intended to exclude from eligibility for payments under the requirements of the 2000 and 2005 laws.

    Thomas F. Kirk, PhD, president, American Orthotic and Prosthetic Association (AOPA), said:   “Taxpayers are seeing billions of dollars go to unlicensed providers in direct violation of what Congress has mandated.  The legitimate industry is being subjected to a misdirected and entirely arbitrary crackdown via government-sanctioned bounty hunters playing by their own set of rules.  And even as unlicensed firms continue to have federal funds lavished on them in violation of the law, the reputable, licensed and legal operators in the industry are being subjected to a regulatory crackdown that is so severe that AOPA has been forced to go to court to challenge it in order to avoid seeing the orthotic and prosthetic industry so enmeshed in pointless government challenges, audits, and other costly and time-consuming red tape that it is unable to meet the urgent needs of patients.”

    Report author Allen Dobson, PhD, said:  “The data from 2001 to 2006, and from 2007 to 2011, show that there has not been any significant change by CMS to eliminate payments to unlicensed providers in orthotic and prosthetic (O&P) licensure states. Specifically, only a small reduction in the proportion of payments to non-certified O&P personnel has been evidenced since 2009. Our analytic results are consistent with the results of a third party independent survey that confirmed that non-certified providers are continuing to provide O&P services to Medicare beneficiaries as recently as in 2013.”

    The American Orthotic and Prosthetic Association supports efforts by Rep. Glenn Thompson (R-PA) and Rep. Mike Thompson (D-CA) to introduce legislation that would go a long ways towards addressing this problem.

    Thomas A. Scully, Esquire, Alston & Bird, former administrator, Centers for Medicare and Medicaid Services, said:   “It’s significant when an entire sector of the health care industry comes to CMS and asks them to regulate them more strongly and protect patients better.  The bill will greatly reduce fraud, protect patients and save money in Medicare’s treatment of a very important and sensitive group of patients.  Keeping out fraudulent providers in the first place is a better way to fight Medicare fraud and abuse instead of ongoing pay and chase methods.”

    Cost savings for Medicare could result from adherence to the law.  As the report notes:  “If CMS was to actively enforce that unlicensed providers cannot receive payment for providing O&P services to Medicare beneficiaries within a licensure state, Medicare savings could be realized. Under such enforcement of limiting payments to providers with proven licensure and standards of training and experience, payments to unqualified providers would be eliminated. As the ’60 Minute’ special suggested, allowing non-certified personnel to provide these services, especially in states with licensure, could lead to fraud and abuse in O&P services, as well as expose patients who received these services to inappropriate or substandard care. Therefore, shifting payments to only certified providers could result in better care for beneficiaries and lower Medicare payments.”

    BACKGROUND

    Congress passed the Benefits Improvement and Protection Act of 2000 (BIPA Section 427) and mandated that within one year of enactment custom fabricated orthotics and all prosthetics must be provided by “qualified practitioners” and “qualified suppliers.” Transmittal 656, effective October 1, 2005, further mandated that CMS should only pay for O&P services for Medicare beneficiaries from practitioners and suppliers that meet state O&P licensure laws. However, no steps were taken to enforce either of these provisions. A total of 14 states have enacted an O&P licensure statute; therefore, despite current practice, only certified personnel are authorized to provide O&P services to Medicare beneficiaries in those states.

    The American Orthotic and Prosthetic Association commissioned Dobson | DaVanzo to analyze Medicare claims data from 2007 through 2011 to determine the extent to which Medicare is reimbursing non-certified O&P personnel in states with a licensure statute for selected O&P services. The analyses conducted by Dobson | DaVanzo was then compared to prior analyses of claims data conducted on behalf of AOPA from 2001 through 2006. The new report summarizes the findings and trends of the data analyses from 2007 to 2011 and compares them to the trends from 2001 to 2006.

    ABOUT AOPA

    The American Orthotic & Prosthetic Association is a national trade association committed to providing high quality, unprecedented business services and products to orthotic & prosthetic (O&P) professionals.   Founded in 1917, AOPA membership consists of more than 2,000 O&P patient care facilities and suppliers that manufacture, distribute, design, fabricate, fit, and supervise the use of orthoses (orthopedic braces) and prostheses (artificial limbs).  For more information, visit https://aopanet.org.

    MEDIA CONTACTS:  Patrick Mitchell, (703) 276-3266, or  pmitchell@hastingsgroup.com .

    EDITOR’S NOTE:  A streaming audio replay of this news event will be available on the AOPA Web site by 5 p.m. EDT on September 17, 2013 at https://aopanet.org

    AOPA to Testify Today during SBA Hearing on Regulatory Fairness

    AOPA will be testifying during today’s Regional SBA Hearing being held in Seattle, WA titled “Regulatory Fairness Hearing for Small Business.”  AOPA will testify on behalf of our members on the RAC and Pre-payment audit practices jeopardizing the economic viability of our members.

    You may read AOPA’s submitted testimony online.

    Background

    This hearing is being held by the U.S. Small Business Administration, Office of the National Ombudsman. The National Ombudsman assists small businesses with unfair and excessive regulatory enforcement by federal agencies including repetitive audits or investigations, excessive fines, penalties, retaliation or other unfair regulatory enforcement actions. The National Ombudsman acts as a “troubleshooter” between small businesses and federal agencies by receiving comments and complaints from small businesses and then directing those comments and complaints to the appropriate federal agency for a high-level review.

    The hearing is designed to provide small business owners, community and business leaders with an opportunity to discuss issues regarding Federal Regulatory Compliance and enforcement.  While this hearing is one of the regularly held hearings mandated by the law that set up the Regulatory Fairness Office and is designed as a general session for all kinds of small business government abuse issues, we plan to use this opportunity to voice concerns about the CMS regulatory issues plaguing O&P small businesses.

    The SBA will also be holding another Regulatory Fairness Hearing on June 21, 20913 in Davenport, Iowa from 8:30 am- 11:30 am.

     

    Next Medicare Open Door Forum to Discuss the CMS Proposed Physician Documentation Template Scheduled for June 13, 2013

    The Centers for Medicare and Medicaid Services has announced that the second of several Open Door Forums to discuss the proposed physician documentation template for O&P services will be held on Thursday, June 13, 2013 from 4pm-5pm EDT.

    AOPA encourages all of its members to participate on this call and provide feedback to CMS regarding its proposed physician template.  AOPA will be represented on the call and is developing an alternate template for submission to CMS.

    Questions regarding this issue may be directed to Joe McTernan or Devon Bernard via email.

     

    Jurisdiction B Publishes Encouraging Results of O&P Pre-Payment Reviews

    National Government Services (NGS), the Jurisdiction B DME MAC, recently reported results of their first quarter pre-payment audit activity on high error rate services, including orthotics and prosthetics.

    While the overall error rate for all claims reviewed remains relatively high at 72%, NGS reported that the error  rate for O&P claims has been significantly reduced. In July 2012, NGS reported a 100% error rate for O&P claims. In the first quarter of 2013, the error rate for O&P claims has been reduced to 46%, representing a 54% improvement from July 2012.

    While NGS has not indicated that this error rate reduction is enough to remove O&P from the list of services subject to pre-payment review, they did indicate that they are encouraged by the significant reduction in the error rate. The most common causes for denial of O&P claims were improper proof of delivery, incomplete medical records to support the medical need of the service provided, and failure to respond to additional documentation requests.

    AOPA encourages its members to continue to provide as much information as possible in response to requests for additional documentation. A continued reduction in the pre-payment error rate may ultimately result in removal of O&P services from the pre-payment review process.

    Questions regarding this issue may be directed to Joe McTernan or Devon Bernard via email.

    CMS Publishes Draft Clinical Template Designed to Assist Physicians to Properly Document Medical Need for Lower Limb Prostheses

    The Centers for Medicare and Medicaid Services (CMS) has published a draft document on its website that, in its words, “will assist physicians with documenting the physician notes that substantiate the need for a Lower Limb Prostheses.”  AOPA believes that the draft template, in its proposed form, actually represents imposition by CMS of a serious new hurdle to Medicare beneficiaries in receiving prostheses and prosthetic components that are necessary to restore their function and facilitate necessary physical rehabilitation.

    The draft template contains four pages of information that physicians are requested to document ranging from the primary complaint of the beneficiary,  to a complete patient history, to a listing of potential co-morbidities that may or may not have any bearing on the patient’s ability to properly wear and function with a particular prosthesis.

    AOPA is very concerned that physician failure to complete the documentation requested in the proposed template will lead to further denial of legitimate prosthetic claims by AOPA members who are effectively meeting the functional needs of their prosthetic patients.

    CMS has announced that they will hold several open door forum conference calls to solicit feedback on the proposed template from the Medicare supplier community.  AOPA plans to attend all of these forums in order to ensure the proper representation of its members concerns regarding the proposed template but is also encouraging individual members to join these calls and provide feedback as well.  The first open door forum is scheduled for Tuesday, May 28, 2013 from 1:00-2:00 p.m. EDT.

    The first link is to the draft template that CMS has published on its website.  This second link contains the dial-in information for the open door forum call scheduled for May 28, 2013. This final link is to the CMS site where all of this information may be found in a consolidated manner.

    AOPA is preparing and will soon release a response to CMS underscoring some significant concerns about and shortcomings of the proposed template. The response, once available, may be viewed here.

     

    Hospital Association RAC Audit Bill Reintroduced

    Last year the American Hospital Association (AHA) whose members are also under siege from RAC audits secured introduction of legislation that would be generally helpful to the plight of hospitals whose audit problems are Part A claims applying to hospitals only but are not unlike the RAC audit issues faced by O&P. But the AHA legislation basically only addresses Part A claims issues applying to hospitals.  It sadly provides no panacea or relief for O&P RAC audit problems. Similar legislation has been introduced in the 113th Congress – S. 1012 and a similar House version HR 1250.

    The AHA, like AOPA, also filed a lawsuit late last year against CMS.  That lawsuit may have been instrumental in CMS making some helpful changes in the audit procedures for the hospitals but those changes did not solve the problem.  The Senate version and House version of the newly introduced legislation are similar to that introduced last year through the auspices of AHA. Click here to read AOPA’s analysis of the AHA legislation and what it will and will not do.

    AOPA is pleased that other organizations whose members are suffering from RAC audit are taking strong actions and helping create further awareness on the part of the general public, the Congress and, ultimately we hope CMS.

    As for an update on AOPA if you haven’t read AOPA’s complaint. You will also want to read https://aopanet.org/advocacy-compliance/our-priorities/the AOPA announcement to members when the lawsuit was filed and you will see information on how you can financially support the lawsuit effort.  The anticipated next step is that CMS during the next 30 to 90 days will likely file a motion to dismiss the AOPA lawsuit.  If our complaint survives that motion and the judge gives the lawsuit a green light, then your Board of Directors will seriously consider seeking a Temporary Restraining Order forcing CMS to revert back to pre-“Dear Physician Letter” audit practices until the case is resolved

    Litigation Fund Draws Impressive Response

    More than 125 companies and individuals have responded with their pocketbooks to help fund the huge lawsuit expense of the AOPA lawsuit  against CMS on behalf of members to stop the craziness that’s disrupting patient care and driving long time O&P providers out of business. $33,200, with contributions ranging in size from $100 to $3,000, has been contributed to date by nearly 13% of the companies in the AOPA membership. Clawbacks of payments for previously approved and paid claims have devastated many O&P businesses so it’s an act of faith and confidence on the part of members that AOPA is doing the right thing by suing CMS. Members know the arduous path AOPA followed over 20 months since the August 2011 HHS Office of Inspector General Report inferring fraud in lower limb prosthetics.  AOPA and O&P Alliance meetings with CMS top officials including three meetings with Administrator Tavenner have not yielded any resolution.  The audits have only accelerated and become more widespread and harmful to patients and members.

     Make donation to the AOPA Litigation and Research Fund

    We know the financial straits many member find themselves in due the RAC and prepayment audits but please give strong consideration to making a contribution and become a charter member of the Heritage Club and receive the deserved ongoing recognition for helping preserve the future of O&P and your business. The large  plaque displayed at future annual events with company names, identifying ribbons attached to World Congress and future National Assembly badges will serve as reminder of how the O&P community stepped up to assure their own survival in the years  to come. As noted in our earlier letter to members announcing the lawsuit,  our world is changing and this may be only the first in a series of legal actions that offer the only pathway for survival.  Lawsuits and research may be the central issues going forward in our changing world. Any contributions will be used only for those purposes – litigation and necessary research.

    Please make your online donation and if you haven’t reviewed the complaint AOPA filed against CMS, you may view it online.