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    • Month: August 2017

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    Medicare Expands Prior Authorization: Five Codes Added

    Friday, Jan 23, 2026

    99th Annual AOPA National Assembly Coming to Boston, Sept. 8-11

    WASHINGTON, D.C. – The 99th Annual AOPA National Assembly is coming to the Hynes Convention Center in Boston, MA. The Annual Assembly is the highlight of the year for the more than 2,200 orthotic, prosthetic and pedorthic professionals expected in attendance – because of its expansive educational opportunities, massive exhibit hall, and engaging events.

    AOPA is proud to unveil Expo Day in the 100,000 square foot exhibit hall, where there will be special events, patient demonstrations and lots of door prizes. Special guests at Expo Day include Jeff Bauman, who became an amputee during the 2013 Boston Marathon Bombing and played a vital role in identifying the bombers. He will be signing copies of his memoir, Stronger to benefit the Wiggle your Toes Foundation. Professional ballroom dancer and bombing survivor Adrianne Haslet-Davis will perform for the crowd and teach interested participants the Waltz or the Rumba.

    The much anticipated Boston Strong Grand Rounds will begin with Adrianne and Heather Abbott sharing their stories of recovery since the bombing. Then a multidisciplinary panel will review three actual case studies of amputee survivors with the medical teams who cared for them. The panel will be moderated by Dr. David Crandell of Spaulding Rehabilitation Hospital, who was involved in the care of 25 of the most severely injured survivors of the bombing, including 15 amputees. The panel includes surgeons, prosthetists and physical therapists from Spaulding, Boston Medical Center, Atrius Health, Brigham & Women’s, Medical Center O&P, and Hanger Clinic.

    Another anticipated program is the session on Osseointegration, a relatively new procedure where a titanium rod is implanted in the bone of the residual limb to attach a prosthetic limb, instead of a traditional socket. The procedure is being used by only a few surgeons worldwide, and several will be on the panel for this discussion.

    The full schedule for the Assembly is online at www.AOPAnet.org.

    Event times and locations:

    Expo Day- Saturday, September 10, 10:00 AM-2:00 PM

    • Jeff Bauman book signing with proceeds benefiting Wiggle Your Toes.
      Location: Auditorium, Aisle 500
      Time: 10:00 AM-2:00 PM
    • Adrianne Haslet-Davis dance performance
      Location: Booth 1629, Hall D
      Time: 10:15 AM
    • Adrianne Haslet-Davis Dance Instruction
      Location: Booth 1629, Hall D
      Time: 10:30 AM

    Education Highlights:

    • Sept. 9, 2:00 pm: About Osseointegrated, Percutaneous Implants for Rehabilitation following Limb Amputation
    • Sept. 10, 2:00 pm: Boston Strong Grand Rounds
    • Sept. 9, 7:30 am: Keynote #1 with Sen. Bob Kerrey
    • Sept. 9, 11:30 am: Keynote #2 with David Gergen, CNN Senior Political Analyst
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    PDAC Announces a Coding Redetermination Project for Custom Diabetic Inserts (A5513)

    On July 13, 2017, the DME MACs published a joint publication that addressed the proper use of HCPCS code A5513, which is used to described molded to patient model diabetic shoe inserts.

    The joint publication indicated that in order to meet the requirements of the HCPCS code descriptor, diabetic inserts billed using A5513 must be molded over an actual model of the patient’s foot.  The publication further clarified that the use of generic, electronic or “virtual” models where custom fabrication occurs without creation of a physical model of the patient’s foot does not meet the code descriptor, and diabetic inserts fabricated this way cannot be billed as A5513.

    On August 10, 2017, the Pricing, Data Analysis, and Coding Contractor (PDAC) announced that based on the previously published coding clarification, it would initiate a Coding Redetermination Project for diabetic inserts described by A5513.  As part of this project, all previous A5513 PDAC coding verifications will be end dated effective May 31, 2018.  Manufacturers and central fabrication facilities who wish to have their products PDAC verified for A5513 will need to submit a new application to the PDAC.  This applies to both new products as well as existing products that were previously verified by the PDAC.  The PDAC has indicated that applications should be submitted well in advance of the May 31, 2018 end date in order to allow adequate time for the PDAC to complete its review.

    The PDAC notice stated that products that are currently PDAC verified for A5513 may continue to be billed using A5513 until the May 31, 2018 end date.  Medicare claims for diabetic inserts described by A5513 with a date of service on or after June 1, 2018 will require a new PDAC coding verification using the requirements outlined in the July 13, 2017 coding clarification.

    As a reminder, AOPA members who are fabricating diabetic inserts described by A5513 for use by their own patients are not required to obtain PDAC verification but must meet the requirements of the code descriptor which includes the creation of a positive model of the patient’s foot. View the complete PDAC announcement.

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