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    Telehealth Waivers Reinstated and Extended Through January 2026

    Thursday, Nov 13, 2025

    The 2020 American Orthotic and Prosthetic Annual National Assembly Begins This Week

    Washington, DC – The American Orthotic and Prosthetic Association (AOPA) will virtually host 1,000 orthotic, prosthetic, and pedorthic professionals for the 2020 AOPA Virtual National Assembly starting tomorrow, September 9-12.

    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 learn about the latest clinical, business, and technology developments, in addition to gleaning insight into the current and future research impacting the profession. Some of the topics that will be covered include business operations during COVID, outcomes and evidence-based practice, treating aging patients, wound healing and diversity in O&P education. Attendees also have access to the Exhibit Hall full of a diverse array of exhibitors that manufacture, supply, and provide services to the O&P profession.

    “The 2020 AOPA Virtual National Assembly provides O&P professionals education from the best in the profession along with access to the latest in technology and devices,” stated Eve Lee, Executive Director, AOPA. “The move to a virtual meeting has enabled us to provide attendees with the opportunity to earn more continuing education credits than any previous Assembly.”

    The Assembly begins Wednesday, September 9 with opening keynote, healthcare futurist Mike Lovdal, PhD.

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

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    DME MACs Clarify AFO/KAFO Policy Article Language Regarding Custom Fabricated Orthoses

    The DME MACs have recently clarified language in the AFO/KAFO Policy Article that currently states the following:

    MISCELLANEOUS

    In addition, if the item is custom fabricated, a complete and clear description of the item, including what makes this item unique, and a breakdown of charges (material and labor used in fabrication). This information should be entered in the narrative field of an electronic claim.

    Previous versions of the Policy Article contained the same language but also included contextual language that clearly indicated that the additional requirements only applied to services described by unlisted procedure codes for lower limb orthoses (L2999).

    Continue reading “DME MACs Clarify AFO/KAFO Policy Article Language Regarding Custom Fabricated Orthoses”

    Member Research Initiative Highlight: Hanger

    The American Journal of Physical Medicine and Rehabilitation recently published a study suggesting that early delivery of a prosthesis following amputation is associated with up to a 25 percent reduction in overall direct healthcare costs. 

    In a recent webinar, a panel of experts reviewed the study’s findings while assessing their impact on patients’ day-to-day lives, and several questions arose as part of that discussion. In this webinar, study co-author and Hanger’s Director, Clinical Research Shane Wurdeman, PhD, CP, FAAOP (D) answers those questions and provides further insight into the importance of these findings to the O&P profession.

    View the webinar.

    CGS Post Payment Review for L0650 Announcement

    In July, we informed you that the Centers for Medicare and Medicaid Services (CMS) announced the resumption of certain audit activity beginning on August 3, 2020. CMS clarified that they will not be restarting all audits on August 3, but instead due to the continued Public Health Emergency (PHE) will be implementing a phased approach to allow suppliers time to prepare and adjust.

    The audits will begin with limited Durable Medical Equipment Medicare Administrative Contractor (DME MAC) based post-payment reviews and will only involve claims with dates of service prior to the beginning of the declared PHE on March 1, 2020.

    CGS, the DME MAC for Jurisdictions B & C, has just announced that they will be conducting a complex post-payment review for L0650, an off-the-shelf LSO. The review will be for claims with dates of service prior to March 1, 2020. If you receive additional documentation requests  as part of this review be sure to respond to them, however  be advised that CMS has implied that the DME MACs may allow for flexibility with extensions and the cancelling of audits based on individual supplier’s ability to complete the audit.

    As of now, there is not a timeframe for when the Target, Probe, and Educate (TPE) program, and other audits will resume. AOPA will continue to monitor the resumption of CMS audit activity and provide you with timely updates.

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

    Take Action: Support O&P and its Patients

    On August 6, the Senate introduced the Medicare O&P Patient-Centered Care Act (S. 4503). This bipartisan legislation would improve access to, and quality of, orthotic and prosthetic care while simultaneously combatting fraud and abuse. The Senate bill is identical to the one introduced in the House late last year (H.R. 5262). The American Orthotic and Prosthetic Association (AOPA) thanks YOU for all your efforts to get this vital legislation introduced in both the House and Senate!

    To move this legislation forward, we need to garner as much support as possible for it. Please take a few minutes to write to your Representative and Senators and urge them to support this important legislation – simply enter your information in on the platform, personalize the letter as you see fit – it’s important to tell YOUR story – and click send.

    These bills would:

    • Distinguish the clinical, service-oriented nature in which O&P is provided from the commodity-based nature of the durable medical equipment (DME) benefit. Orthotics and prosthetics care includes a patient care component that is decidedly more in-depth and personal than simply supplying DME. Most orthotic and prosthetic devices are custom fabricated or custom fit and require the expertise of an orthotist or prosthetist who receive Master of Science degrees and residence training before becoming certified practitioners. Distinguishing O&P from DME would also create a path to billing for telehealth, which is increasingly important during the COVID pandemic.
    • Restore congressional intent by revising the overly expansive regulatory interpretation of the meaning of “off-the-shelf” (OTS) 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. Congress created a definition of OTS orthotics as devices “requiring minimal self-adjustment for appropriate use” that “do not require expertise in trimming, bending, molding assembling, or customizing to fit to the individual.” However, the Centers for Medicare and Medicaid Services (CMS) has changed and expanded the definition beyond Congress’ intent. CMS defines minimal self-adjustment as an adjustment the “beneficiary, caretaker for the beneficiary or supplier can perform” – which is clearly not “self-adjusted.” This expansion of Congress’ definition places beneficiaries at risk for harm if they receive orthotic devices without the services that are necessary to ensure that these devices provide proper bracing.
    • Reduce the likelihood of waste, fraud, and abuse in the Medicare program by prohibiting the practice of “drop shipping” (shipping an orthoses or prostheses to a beneficiary without first receiving direct patient care from a trained, certified or licensed health care practitioner) of orthotic braces that are not truly “off-the-shelf” (i.e., subject to minimal self-adjustment by the patient him- or herself).

    All it takes is a few minutes, please take the time and write your legislators TODAY and urge them to support these important bills. Educating Congress on the issues surrounding the O&P profession is vital to businesses and more importantly patients – if we don’t advocate for our needs and the needs of patients, no one will.

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

    Thank you for your efforts!

    Medicare Orthotics and Prosthetics Patient-Centered Care Act Introduced in the Senate

    Washington, DC – Yesterday, Senators Mark R. Warner (D-VA), Steve Daines (R-MT), Tammy Duckworth (D-IL), John Cornyn (R-TX), and Bill Cassidy (R-LA) introduced the Medicare Orthotics and Prosthetics Patient-Centered Care Act (S. 4503) in the Senate.

    “The American Orthotic and Prosthetic Association applauds the introduction of the Medicare Orthotics and Prosthetics Patient Centered Care Act and greatly appreciates the support and efforts of its cosponsors, Senators Warner, Daines, Duckworth, and Cassidy,” said Eve Lee, MBA, CAE, Executive Director of the American Orthotic and Prosthetic Association. “We look forward to working with Congress to pass this important piece of legislation.”

    The Act has four provisions, the first would create separate statutory requirements for the provision of orthoses and prostheses to reflect the distinction between the clinical, service-oriented nature of orthotics and prosthetics care and the commodity-based nature of durable medical equipment. The second would restore Congress’ intended meaning of the term “minimal self-adjustment,” to more clearly define off-the-shelf orthoses that subject to Centers for Medicare and Medicaid Services’ competitive bidding program. Third, it would prohibit the practice of “drop shipping” custom orthoses and prostheses to Medicare beneficiaries, and prohibit drop shipment of off-the-shelf orthoses. This provision would reduce ongoing Medicare waste, fraud, and abuse in the orthotic and prosthetic benefit; the Department of Justice uncovered $1.2 billion in fraud through last year’s “Operation Brace Yourself,” and recently, in the midst of the pandemic, several owners of medical equipment companies have been charged with submitting false and fraudulent claims to Medicare for orthotic braces that were medically unnecessary, ineligible for Medicare reimbursement, or not provided as represented. Finally, the Act ensures that patients have access to the full range of orthotic care from one orthotic/prosthetic practitioner rather than requiring patients to visit multiple providers in the case where the treating orthotist or prosthetist does not have a competitive bidding contract. This provision helps ensure efficient and convenient patient care and is similar to the treatment afforded physicians and other practitioners.

    “The provision of orthotics and prosthetics care requires clinical services provided by highly trained practitioners. Currently, it is unfairly regulated through a DME lens instead of the clinical care lens,” said Jeff Lutz, CPO, President of the American Orthotic and Prosthetic Association. “By differentiating the clinical care in which orthoses and limb prostheses are provided from the provision of durable medical equipment, this important legislation will ensure patients get the safe, quality care they deserve.”

    The companion bill, H.R. 5262 was introduced in the House on November 22, 2019. Like in the Senate, the bill enjoys broad bipartisan support.

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    Medicare Orthotics and Prosthetics Patient-Centered Care Act Introduced in the Senate

    Contact: Joy Burwell
    jburwell@AOPAnet.org
    757-646-4999

    FOR IMMEDIATE RELEASE

    Medicare Orthotics and Prosthetics Patient-Centered Care Act Introduced in the Senate

    Washington, DC (August 7, 2020) – Yesterday, Senators Mark R. Warner (D-VA), Steve Daines (R-MT), Tammy Duckworth (D-IL), John Cornyn (R-TX), and Bill Cassidy (R-LA) introduced the Medicare Orthotics and Prosthetics Patient-Centered Care Act (S. 4503) in the Senate.

    “The American Orthotic and Prosthetic Association applauds the introduction of the Medicare Orthotics and Prosthetics Patient-Centered Care Act and greatly appreciates the support and efforts of its co-sponsors, Senators Warner, Daines, Duckworth, and Cassidy,” said Eve Lee, MBA, CAE, Executive Director of the American Orthotic and Prosthetic Association.  “We look forward to working with Congress to pass this important piece of legislation.”

    Continue reading “Medicare Orthotics and Prosthetics Patient-Centered Care Act Introduced in the Senate”

    Update on CMS Resumption of Medicare Audits

    On July 10, we informed you that the Centers for Medicare and Medicaid Services (CMS) announced the resumption of certain audit activity beginning on August 3, 2020.

    AOPA, through its involvement on the DME MAC Advisory Councils has since learned that CMS has clarified the scope of the audits that will resume on August 3. CMS will not be restarting all audits on August 3, but instead due to the continued Public Health Emergency (PHE) will be implementing a phased approach to allow suppliers time to prepare and adjust. The audits will begin with limited DME MAC based post-payment reviews and will only involve claims with dates of service prior to the beginning of the declared PHE on March 1, 2020. 

    As of now CMS did not provide a timeframe for the next phase or for the renewal of audit activity through the Target, Probe, and Educate (TPE) program, RAC audits or SMRC audits. CMS also reiterated that the DME MACs may allow for flexibility with extensions and the cancelling of audits based on individual supplier’s ability to complete the audit.
     
    AOPA will continue to monitor the resumption of CMS audit activity and provide you with timely updates.

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

    AOPA is Pleased to Announce the 2020 Thranhardt Award Winners

    Washington, DC – Anton Johannesson, PhD, CPO, Caitlin Deom, PT, DPT, and John Frederick, CPO/L are recipients of the 2020 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 2020 American Orthotic and Prosthetic Association Virtual National Assembly on September 10.

    “These individuals represent the best in orthotic and prosthetic patient care and the American Orthotic and Prosthetic Association is proud to name them as 2020 Thranhardt Award winners,” said Jeff Lutz, CPO, President, American Orthotic and Prosthetic Association. “The Thranhardt Lectures are a highlight for National Assembly attendees. We look forward to hearing about their research and honoring them September.”

    CMS Announces the Resumption of Medicare Audits and New Implementation Date for Medicare Prior Authorization

    The Centers for Medicare and Medicaid Services (CMS) recently updated its COVID-19 Reduction of Provider Burden Frequently Asked Questions (FAQ) document to provide updates on the resumption of Medicare audit activity and revised implementation dates for Medicare prior authorization of six lower limb prosthesis codes.

    Resumption of Medicare Audits

    The FAQ was updated to indicate that CMS has authorized Medicare contractors (e.g. DME MACs, RACS, SMRCs, etc.) to once again perform pre-payment and post-payment audits as part of their medical review responsibilities.  CMS had suspended most audits as of March 30, 2020 due to the COVID-19 Public Health Emergency (PHE).  In the updated FAQ, CMS indicates that due to the “importance of medical review activities to CMS’ program integrity efforts, CMS expects to discontinue exercising enforcement discretion beginning on August 3, 2020, regardless of the status of the public health emergency.”  CMS indicates that if individual providers are selected for medical review believe that responding to a request for documentation will create a hardship situation, they should discuss response options with the contractor performing the review.

    It is important to note that CMS authorized the reinstatement of all Medicare audits, not just audits of orthotic and prosthetic claims.

    The timing of the resumption of audit activity is surprising considering that the PHE remains in effect and AOPA will be communicating our concern to CMS about the burdens that renewed audit activity will place on providers that are already operating under challenging circumstances.

    Update on Medicare Prior Authorization

    The updated FAQ also included new implementation dates for the Medicare Prior Authorization program for the six lower limb prosthesis codes (L5856, L5857, L5858, L5973, L5980, and L5987) that had their original implementation delayed due to the COVID-19 PHE.  CMS announced that Medicare prior authorization for the six codes will begin in the four states previously selected for the initial roll out (PA, MI, TX, and CA) on September 1, 2020 and will be implemented nationally on December 1, 2020.

    AOPA has developed resources to assist members to understand how the prior authorization process will work and what to expect from it.  These resources, including live and on demand education opportunities will be made available to AOPA members soon.

    View the updated CMS FAQ document.

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