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Wednesday, Oct 08, 2025

CMS Releases the 2020 Medicare DMEPOS Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) has released the 2020 Medicare DMEPOS fee schedule which will be effective for Medicare claims with a date of service on or after January 1, 2020.  As anticipated, the 2020 Medicare fee schedule for orthotic and prosthetic services will be increased by 0.9% over 2019 rates. The 0.9% increase is a net reflection of the 1.6% increase in the Consumer Pricing Index for Urban Areas (CPI-U) from June 2018 through June 2019, combined with the annual Multi-Factor Productivity Adjustment (MFP) of -0.7%.

Click here to view the official CMS announcement for the 2020 DMEPOS fee schedule update.

Click here to view and download the complete 2020 Medicare DMEPOS fee schedule.

Questions regarding the 2020 Medicare fee schedule may be directed to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.

Action Needed: Support the Medicare O&P Patient-Centered Care Act

Friday, November 22, the House of Representatives introduced the Medicare O&P Patient-Centered Care Act (H.R. 5262). This bipartisan legislation would improve access to, and quality of orthotic and prosthetic care received by Medicare beneficiaries while simultaneously combatting fraud and abuse. Specifically, this bill would:

  • Restore congressional intent by revising the overly expansive regulatory interpretation of the meaning of “off-the-shelf” orthotics to clarify that competitive bidding may only apply to orthoses that require minimal self-adjustment by patients themselves, not the patient’s caregiver or a supplier.
  • Distinguish the clinical, service-oriented nature in which O&P is provided from the commodity-based nature of the durable medical equipment benefit.
  • Reduce the likelihood of waste, fraud, and abuse in the Medicare program by prohibiting the practice of “drop shipping” of orthotic braces that are not truly “off-the-shelf” (i.e., subject to minimal self-adjustment by the patient him- or herself).

We need your help, if we don’t advocate for our needs and the needs of patients, no one will. Visit AOPAvotes and take a few minutes to write your legislator and urge them to support this important legislation.

If you have any questions, contact Justin Beland, AOPA Director of Government Affairs at jbeland@AOPAnet.org.

Thank you for your support, together we can continue to improve the lives of those living with limb loss and limb impairment.

HHS OIG Releases Report Comparing Medicare Payment for Orthoses with Payments by Other Insurers

HHS Office of Inspector General Releases a Report Comparing Medicare Payment for Orthoses with Payments by Other Insurers

On October 30, 2019, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report that compared Medicare payments for orthoses to payments made by non-Medicare payers from 2012-2015.  The OIG cited an increase in Medicare payments for certain spinal, knee, elbow, and wrist orthoses from $631.8 million in 2012 to $815.5 million in 2015 as the reason for conducting its investigation.  The OIG reported that for 142 orthosis codes, Medicare paid $337.5 million more than non-Medicare payers during the three-year review period.  The OIG reported that for 19 orthotic codes, Medicare actually paid $4.7 million more than non-Medicare payers during the same three-year period. 

CMS Issues Final Rule on 2020 Medicare Payment Rules for DMEPOS

On October 31, 2019, the Centers for Medicare and Medicaid Services (CMS) released its annual final rule regarding changes to the 2020 Medicare payment rules for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).  CMS issued a proposed rule in late July of this year and allowed any interested member of the public to provide written comments on the proposed rule until September 27, 2019.

AOPA reviewed the proposed rule and submitted comments on several proposed changes to Medicare DMEPOS payment policy for 2020.  AOPA’s concerns focused on proposed changes to the gap filling methodology that Medicare is statutorily required to use to establish Medicare fee schedules for new HCPCS codes, the proposed combination and expansion of the CMS “master list” of HCPCS codes subject to prior authorization, face to face visit requirements, and written orders prior to delivery (WOPD), and the authority of CMS to reduce Medicare fee schedules for products that have had price reductions through market competition within five years of creation of a new HCPCS code.

While CMS acknowledged all of the comments it received in response to the proposed rule, the only section of the proposed rule that it elected not to finalize was a provision that would use technology assessments, which would compare new DMEPOS technology to existing DMEPOS technology in order to help CMS establish Medicare fee schedules for new HCPCS codes.  CMS decided to consider this provision of the proposed rule in the future.  All other provisions of the proposed rule related to DMEPOS were finalized in the final rule despite significant concerns from the public expressed in response to the proposed rule.

The significant changes to DMEPOS payment policy for 2020 that were created by the final rule include:

  1. Changes to the CMS gap filling process that will allow CMS to use retail prices found online and in catalogs and comparative analysis of existing technology to new technology to establish baseline pricing that will then be deflated back to 1986 prices and re-inflated to current day prices. AOPA expressed concern that using pricing sources that did not account for clinical care in the delivery of O&P service would create an artificially low baseline that would be further reduced through the statutory gap filling process.
  2. Expansion of the CMS “master list” of HCPS codes subject to prior authorization, face to face visit requirements, and/or written orders prior to delivery. Currently 82 O&P HCPCS codes are potentially subject to Medicare prior authorization.  The final rule reduced the financial threshold for inclusion on the master list from an average reimbursement of $1,000 to an average reimbursement of $500.  This reduction in the reimbursement threshold expands the list of eligible O&P codes to 226 codes.  In addition, the final rule also exposes the 226 O&P codes to potential inclusion in Medicare requirements for face to face visits with prescribing practitioners and written orders prior to delivery, two requirements that were previously not applicable to O&P services.
  3. Expansion of CMS authority to reduce Medicare fee schedules when CMS determines that market competition has driven the price of new technologies down within 5 years of creation of a HCPCS code. AOPA’s comment on this provision of the proposed rule was that CMS already has the authority, through the inherent reasonableness process, to reduce Medicare fee schedules that are deemed to be excessively high or low.  CMS disagreed with AOPA’s comment on this provision and elected to finalize the expansion of its own authority in this regard.

AOPA is disappointed in CMS’ lack of response to the comments it received regarding the proposed rule.  In most instances, CMS simply stated that they disagreed with the submitted comments with minimal explanation as to why and indicated that it would finalize the proposed provision as written.

AOPA understands the importance of establishing and maintaining a positive relationship with CMS and its value in achieving AOPA’s mission of improving patient access to quality orthotic and prosthetic care through advocacy, research, and education.  AOPA continues to strive toward creating effective, two-way communication with CMS, its contractors, and its leadership.  Past successes include efforts to prevent the creation of an unreasonable, non-patient focused local coverage determination for lower limb prostheses, AOPA representation on the DME MAC Advisory Councils and successful challenges to inappropriate RAC audit activity.  AOPA will continue to press CMS for better transparency and greater stakeholder input in its policy making process and continue efforts to be the voice of the O&P profession on policy issues.

The complete final rule may be viewed here.

Corporate Compliance & Ethics Week ~ November 3-9, 2019

Next month, AOPA and our members are celebrating Corporate Compliance & Ethics Week with daily activities. AOPA encourages its members to make the right choices all year long, and celebrate Corporate Compliance & Ethics Week with AOPA! AOPA’s first HCEW was November 5-11, 2017. This year’s celebration will take place November 3-9. Every day AOPA will send out a Compliance Tip and question of the day. Answer each day’s Compliance question for a chance to win one of three daily prizes: 

The American Orthotic and Prosthetic Association Heads to San Diego for the 102nd Annual National Assembly

Washington, DC – The American Orthotic and Prosthetic Association (AOPA) will host over 2,000 orthotic, prosthetic, and pedorthic professionals for the 2019 AOPA National Assembly, September 25-28 at the San Diego Convention Center.

The Assembly is the country’s oldest and largest meeting for the orthotic, prosthetic, and pedorthic profession, this includes companies that manufacture and supply orthoses and prostheses as well as the clinicians who provide the care. Attendees will gather to network with their peers, learn about the latest technology developments, and glean insight into the current and future research impacting the profession. The vast array of topics that will be covered includes outcomes and evidence-based practice, the need for transparent, valuebased funding, technology advancements, and osseointegration. The education sessions are accompanied by an Exhibit Hall full of a diverse array of over 150 exhibitors that manufacture, supply, and provide services to the O&P profession.

“The 2019 AOPA National Assembly provides O&P professionals education from the best in the profession, access to the latest in technology and devices, and opportunities to network and have fun with their colleagues, there truly is something for everyone,” stated Eve Lee, Executive Director, AOPA. “This year’s Assembly has all the events attendees have come to expect as well as new opportunities intended to help them continue to successfully run their business and provide quality patient care.”

The Assembly begins Wednesday, September 25 with opening keynote Captain Lanny Boswell, USN (Ret), PhD, PT, OCS. It will also feature country rocker Eddie Montgomery who will perform top Montgomery Gentry hits “Gone,” “Hell Yeah,” “Something to Be Proud of,” and “My Town” at the Veterans Stride Foundation Benefit Concert Thursday, September 26. On Saturday, September 28, Paralympian Jeremy Campbell will address attendees before the Exhibit Hall opens to the public for O&P Expo Day, a unique opportunity to for the public to explore the world of O&P and interact with O&P suppliers showcasing the latest technology, devices, supplies, tools, services, components, and solutions.

For more information on the Assembly including the full schedule visit www.AOPAssembly.org.

Competitive Bidding Reminder: Time to Register for DBids is Running Out, Deadline is 8/16

If you intend to submit a bid for the Round 2021 Competitive Bidding Program, you must register with the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Bidding System, DBidS, by this Friday, August 16. If you have not already done so, all registrations must be completed by 8:59:59 p.m. ET. If you have not registered by then you will not be able to submit a bid.

To register visit the Competitive Bidding Implementation Contractor’s website.

Registration for Connexion, the secured portal for uploading your financial documents, will remain open, only DBidS registration closes Friday, August 16.

As a reminder you have until September 18, 2019 to submit your financial documents. However, if you upload the documents by August 19 they will be reviewed and you will be notified of any missing required documents, and have time to provide the missing documents.

Questions? Contact Joe McTernan, jmcternan@aopanet.org, or Devon Bernard, dbernard@aopanet.org

 

CMS Releases Proposed Rules for ESRD PPS & Gap-Filling Methodologies

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to update the End Stage Renal Disease (ESRD) Prospective Payment System (PPS), and included in the proposed rule were major changes to the gap-filling methodology. Gap-filling is the current procedure for how new introduced products and HCPCS codes receive a fee schedule amount.

AOPA staff is currently reviewing the proposed rule in more detail.

Questions? Contact Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.

2019 Thranhardt Award Winners Announced

WASHINGTON, D.C. – Tiffany Graham, MSPO, CPO, LPO, FAAOP, Kelly Millay, MPO, and Andreas Hahn, PhD, MSc, are the recipients of the 2019 Howard R. Thranhardt Award. The Award, established in 1996 by a gift from J.E. Hanger in memory of Howard R. Thranhardt, CP, has become one of the most distinguished honors in the orthotics and prosthetics profession. The winners will present their research at the 2019 American Orthotic and Prosthetic Association National Assembly in San Diego on September 26.

“The American Orthotic and Prosthetic Association is proud to announce the 2019 Thranhardt Award winners. They represent the best in orthotic and prosthetic patient care,” said Jim Weber, MBA, President, American Orthotic and Prosthetic Association. “The Thranhardt Lectures have become a highpoint for National Assembly attendees. We look forward to celebrating the winners in San Diego.”

Graham and Millay will present Significant Factors in Orthotic Treatment of Asymmetrical Brachycephaly. Graham received her bachelors in Engineering Science from Trinity University and her MSPO from the Georgia Institute of Technology. She has focused her career in pediatric orthotics and has over 10 years of experience with treating cranial deformations. Graham is an instructor at the University of Texas Southwestern Medical Center, Vice-Chair of the Academy’s Craniofacial Society, and recipient of the 2018 Thranhardt Award. Millay received her BS in Bioengineering from University of Louisville and her MPO from University of Texas Southwestern Medical Center. She is currently an orthotic resident at University of California at San Francisco and a member of the Academy’s Craniofacial Society. Her research interest focuses in cranial deformations.

Hahn will present The Use of Health Economic Instruments to Evaluate Prosthetic Services: Experience with Over 400 Patients in Germany and India. He joined Ottobock in 2004 and currently holds the global corporate responsibility for Ottobock’s Clinical Research activities. Hahn is a physicist at Oxford University, has over 20 years professional experience in leading positions in the Medical Device Industry, and was a 2014 Thranhardt Award winner.

More information about the 2019 National Assembly is available at www.AOPAassembly.org.