As part of its update to its 2018 work plan, the Department of Health and Human Services Office of Inspector General (OIG) announced that, based on abnormally high utilization and unusually high improper payment rates, two off the shelf (OTS) HCPCS codes that describe lumbar sacral orthoses (L0648 and L0650) and one OTS knee orthosis […]
On January 11, 2018, as part of its quarterly HCPCS update, the Centers for Medicare and Medicaid Services (CMS) issued a new HCPCS code to describe direct milled, custom fabricated diabetic inserts. The new code is effective April 1, 2018 reads as follows: K0903–For Diabetics Only, Multiple Density Insert, Made By Direct Carving With CAM […]
On January 9, 2018, CMS published its final changes to the DMEPOS Quality Standards, specifically the standards that address the definition of the term “molded to patient model” as it relates to the provision of custom fabricated diabetic inserts. CMS made only one small change to the definitions it included in its November 2, 2017 […]
The Centers for Medicare and Medicaid Services (CMS) has released the 2018 Medicare DMEPOS fee schedule which will be effective for Medicare claims with a date of service on or after January 1, 2018. The 2018 Medicare fee schedule for orthotic and prosthetic services will be increased by 1.1% over 2017 rates. The 1.1% increase […]
The October 16, 2017 Federal Register included a proposed rule published by the Department of Veterans Affairs (VA) that intends to “reorganize and update the current regulations related to prosthetic and rehabilitative items, primarily to clarify eligibility for prosthetic and other rehabilitative items and services, and to define the types of items and services available to eligible […]
On December 11, 2017, AOPA submitted formal comments on CMS’ proposed change to the DMEPOS Quality Standards that would expand the definition of the term “molded to patient model” to include custom fabricated diabetic inserts that are fabricated using a virtual or digital model of the patient’s foot and a direct milling process. Earlier this […]
Submit comments on the CMS proposed changes to the DMEPOS quality standards that would include a 14% reduction in reimbursement for custom fabricated, direct milled diabetic inserts. In July, the DME MACs released a clarification stating that diabetic inserts billed using A5513 must be molded over an actual model of the patient’s foot. At that […]
On November 28, 2017, AOPA participated in a Special Open Door Forum hosted by the Centers for Medicare and Medicaid Services (CMS). The purpose of the Special Open Door Forum was to receive input from experts and stakeholders regarding proposed changes to the DMEPOS quality standards that would expand the definition of the term “molded […]
On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule in the Federal Register entitled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2019.” Among the provisions in the proposed rule is a section that would provide individual states with increased flexibility in […]
The Centers for Medicare and Medicaid Services (CMS) has released the new HCPCS codes for 2018, and there were only a few minor changes. Below is a complete breakdown of the code changes which will be effective for claims with a date of service on or after January 1, 2018. New Codes Changes in Code […]
