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    • Month: June 2020

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    Medicare Expands Prior Authorization: Five Codes Added

    Friday, Jan 23, 2026

    Action Needed: Ask Your Senators to to Support Funding for O&P Education

    This week the Senate will start debate on the National Defense Authorization Act (NDAA), which lays out the 2021 budget and expenditures of the U.S. Department of Defense (DoD) and creates new programs within the DoD. Senators Richard Durbin (D-IL), Tammy Duckworth (D-IL), and David Purdue (R-GA) have introduced an amendment to the bill which would provide competitive grants to universities to create or expand graduate degree programs in orthotics and prosthetics. Please take a few minutes to write your Senators and urge them to support this amendment.

    An increased orthotic and prosthetic workforce is essential to support military readiness and ensure that servicemembers who experience limb loss or limb impairment are able to receive the expert orthotic and prosthetic care they need and deserve. Over the past decade, new technologies and devices have been developed to address the increasingly complex medical conditions facing the growing population of men and women who have served our country in the Armed Forces. To take advantage of these innovations, clinicians require more sophisticated and advanced training, with entry level positions in orthotics and prosthetics requiring a master’s degree from an accredited institution and completion of a residency program. These programs are costly to establish and sustain, requiring extensive hands-on lab work and equipment.

    Despite the growing demand for orthotic and prosthetic care, there are only twelve schools offering a master’s degree program in this field, collectively graduating fewer than 250 students per year. A 2015 study from the National Commission on Orthotics and Prosthetics Education (NCOPE) concluded that the workforce of credentialed orthotic and prosthetic providers needs to increase by about 60 percent by 2025 to meet the growing demand for care.

    All it takes is two minutes to send a letter to your Senators asking them to include orthotic and prosthetic workforce pilot program language in the NDAA legislation. Doing this can make a tremendous difference. We appreciate your commitment to ensuring that future Wounded Warriors with limb loss and limb impairment will be able to receive the quality orthotic and prosthetic care they need and deserve.

    Questions may be directed to Justin Beland, AOPA’s Director of Government Affairs at jbeland@AOPAnet.org.

    DME MACs and PDAC Release Joint Publication Announcing Coding Verification Requirement for Six Lower Limb Prosthetic Codes that Will Require Medicare Prior Authorization

    On June 26, 2020, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and Pricing, Data Analysis, and Coding Contractor (PDAC) released a joint announcement for a new coding verification requirement for the six lower limb prostheses that were previously announced as  subject to Medicare prior authorization. While implementation of Medicare prior authorization has been postponed due to the COVID-19 public health emergency, it is expected that the program will be implemented in the future.

    The joint publication announced that, effective for claims with dates of service on or after January 1, 2021, the only products which may be billed using codes L5856, L5857, L5858, L5973, L5980, and L5987 are those for which a written Coding Verification Review has been made by the PDAC and is listed on the PDAC Product Classification List.

    In addition to the joint DME MAC/PDAC publication announcing the coding verification requirement for the six prosthetic codes discussed above, the four DME MACs simultaneously released a revised version of the Lower Limb Prostheses Policy Article (PA) with an effective date of August 1, 2020.  The revised PA includes new coding guidelines for L5856, L5857, L5858, L5980, L5981 and L5987.  Coding guidelines for L5973 were published in a previous (January 2020) Policy Article revision.

    AOPA’s Coding and Reimbursement Committee will be undertaking a comprehensive review of the Policy Article coding guideline revisions as well as the coding verification requirement and will engage in collaborative discussions with the PDAC and the DME MACs.

    The joint publication announcing the coding verification requirement may be viewed here. And view the revised Lower Limb Prosthesis Policy Article here.

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

    Registration for the 2020 Virtual National Assembly is Open

    Even though we won’t be face-to-face, the 2020 Virtual National Assembly will have it all…

    • The best in business education and advanced clinical programming offered in general sessions, poster presentations, and engaging concurrent breakouts.
    •  A robust exhibit hall.
    • Roundtable discussions with the most influential people in the profession.
    • Fun events such as coffee breaks and live entertainment.
    • The opportunity to earn a substantial amount of CE credits. Education will be available 30 days post Assembly, giving you the opportunity to go back and attend multiple concurrent sessions.
    • An easy to use platform that is mobile, computer, and tablet responsive. Plus, access to training and a dedicated help desk.
    • No travel required, saving you time and money.

    You won’t want to miss out, register today!  

    View the tentative schedule here and stay tuned for the specifics on education.

    Questions? Contact info@AOPAnet.org or (571) 431-0876.

    COVID-19 Update: Paycheck Protection Program Changes

    This week Congress finalized legislation to ensure that businesses that received a forgivable loan through the Paycheck Protection Program (PPP) can have more leeway on how to spend those funds.

    Under the newly-passed Paycheck Protection Program Flexibility Act of 2020 small businesses would have to spend just 60 percent of the loan money on payroll instead of 75 percent as outlined in the original law. In addition, current PPP borrowers can choose to extend the eight-week period of the disbursement to 24 weeks, or they can keep the original eight-week period if their business has sufficiently recovered. New PPP borrowers will have a 24-week covered period, but the covered period can’t extend beyond December 31, 2020. Borrowers can use the 24-week period to restore their workforce levels and wages to the pre-pandemic levels required for full forgiveness. This must be done by December 31, 2020, a change from the previous deadline of June 30, 2020.

    The bill includes two exceptions allowing borrowers to reach full PPP loan forgiveness even if they aren’t able to fully restore their workforce. Previous guidance already allowed borrowers to exclude from those calculations employees who turned down good faith offers to be rehired at the same hours and wages as before the pandemic. The new bill allows borrowers to adjust because they could not find qualified employees or were unable to restore business operations to February 15, 2020, levels due to COVID-19 related operating restrictions.

    Finally, the bill extends a June 30, 2020 deadline to rehire workers, pushes back the timeline for repaying loans, and allows companies that get loan forgiveness to defer payroll taxes. 

    The President is expected to sign the bill into law shortly. For questions, please contact Justin Beland, Director of Government Affairs at jbeland@aopanet.org, and keep checking our COVID-19 resources page for more updates.

    Statement from AOPA on Systematic Racism

    The death of George Floyd, the protests, and the disproportionate impact COVID-19 is having on racial and ethnic minorities and the poor and socially disadvantaged among us has once again brought to the forefront the long-standing issue of systematic racism in this country.

    The American Orthotic and Prosthetic Association (AOPA) stands with our members in opposing systemic racism and believes it is time to meaningfully address the impacts it has on our society. Until we do, a large percentage of the patients AOPA members serve, those living with limb loss/difference and limb impairment in disadvantaged communities, will never be truly healthy.

    Now more than ever, it is imperative to reflect on the values of the orthotics and prosthetics profession and its patients, to remember character is not only what we believe but what we do. As Martin Luther King, Jr. observed, “The ultimate tragedy is not the oppression and cruelty by the bad people but the silence over that by the good people.”

    Today, we reaffirm our values, beliefs, and commitments. We cannot solve these problems alone, but AOPA is committed to the principles of diversity, equality, and inclusion with each other, our allied healthcare professionals, and in all patient interactions. AOPA is committed to health equity and to improving the health outcomes of our patient populations. AOPA stands united, ready to learn, grow, and work toward a better future.

    About the American Orthotic and Prosthetic Association (AOPA): Through advocacy, research, and education, AOPA improves patient access to quality orthotic and prosthetic care. AOPA, based in Alexandria, VA, is the largest non-profit organization consisting of more than 2,000 O&P patient care facilities and suppliers, dedicated to helping O&P businesses and professionals navigate the multitude of issues surrounding the delivery of quality patient care.