Month: December 2018

The Centers for Medicare and Medicaid Services (CMS) has released the 2019 Medicare DMEPOS fee schedule which will be effective for Medicare claims with a date of service on or after January 1, 2019.  The 2018 Medicare fee schedule for orthotic and prosthetic services will be increased by 2.3% over 2018 rates. The 2.3% increase is a net reflection of the 2.9% increase in the Consumer Pricing Index for Urban Areas (CPI-U) from June 2017 through June 2018, combined with the annual Multi-Factor Productivity Adjustment (MFP) of -0.6%.

The 2.3% increase in the O&P Medicare fee schedule for 2019 represents a 1.2% larger amount than the 2018 increase of 1.1%.  Unfortunately, the 2% sequestration-based reduction to all Medicare payments remains in effect meaning that Medicare fee for service payments will continue to be reduced by 2% due to sequestration.  While sequestration continues to impact Medicare reimbursement, it is not cumulative.  You will still receive 2.3% more for a service you provide in 2019 then you did in 2018 since the 2% sequestration reduction would be applied to both claims.

Click here to view and download the complete 2019 Medicare DMEPOS fee schedule.

As always, AOPA maintains the most current Medicare fee schedule information and will be happy to provide it to AOPA members.

Questions regarding the 2019 Medicare fee schedule may be directed to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.

On November 28, 2018, the Department of Veterans Affairs (VA) released a Supplemental Notice of Proposed Rulemaking (SNPRM) regarding the provisions of the October 2017 proposed rule that addressed the Veterans right to choose their provider for provision of artificial limbs.  The SNPRM was issued in response to the significant comments that the VA received on these provisions in the original, yet to be finalized proposed rule.

The heart of this issue is whether the VA has the right to determine whether a veteran must receive prosthetic care within the confines of the VA medical center system or whether they have the right to choose to work with contracted providers within the community.  For many years, this has not been an issue as veterans, in most cases, were free to receive prosthetic care directly from the VA or from contracted providers.  The October 2017 proposed rule clearly indicated that the VA, and solely the VA had the authority to determine where veterans received prosthetic services.

In its comment on the proposed rule, AOPA strongly objected to the proposed change, as did other groups, including several veterans service organizations.

The SNPRM addresses the comments it received on this issue and “seeks to clarify the intent of the proposed regulation, explain the VA’s current practices and processes relating to the provision, and request additional details on it.”

AOPA’s preliminary review of the SNPRM indicates that the VA still contends that it reserves the right to full discretion regarding how a veteran receives prosthetic services including whether the veteran can seek care from community-based prosthetists.  While the SNPRM discusses the involvement and importance of community-based care in certain circumstances, AOPA believes that the VA remains overly restrictive in the SNPRM and its authority to determine where a veteran receives prosthetic services.

Comments on the SNPRM are due on December 28, 2018.  AOPA will complete its review of the SNPRM and will be filing comments accordingly.  The complete SNPRM may be viewed here.

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