On November 13, 2018, the DME MACs published a revised Dear Physician letter that addresses the Medicare requirements for documentation within the referring physician’s medical records that support the medical necessity of orthotic and prosthetic services provided to Medicare beneficiaries.  This letter replaces an early Dear Physician letter, issued in August, 2011 that was retired […]

On November 1, 2018, the Centers for Medicare and Medicaid Services (CMS) announced that it is soliciting comments on its proposed inclusion of off-the-shelf spinal orthoses and off-the-shelf knee orthoses as product categories in the next round of Medicare competitive bidding.  This announcement came on the same day that the final rule on changes to […]

The Centers for Medicare and Medicaid Services (CMS) has released the new Healthcare Common Procedure Coding System (HCPCS) codes for 2019, and there were 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, 2019. New […]

On November 1, 2018 the Centers for Medicare and Medicaid Services (CMS) published a final rule that addressed changes to the DMEPOS Competitive Bidding program and potential changes to the gap filling methodology that is currently used to establish Medicare fee schedules for new HCPCS codes. The final rule followed a proposed rule that was […]

On November 1, 2018, the four Durable Medical Equipment Medicare Administrative Contractors (DME MACs) released an updated Local Coverage Determination (LCD) for lower limb prostheses.  Since the changes to the LCD were minimal and do not restrict coverage, the notice and comment period required by the 21st Century Cures Act does not apply to this […]

The American Orthotic & Prosthetic Association (AOPA) in partnership with The Journal of Neuroengineering and Rehabilitation, JNER, a BioMed Central journal partner, is pleased to announce that the supplement, “Advancements in Prosthetics and Orthotics: Selected articles from the Second World Congress hosted by the American Orthotic & Prosthetic Association (AOPA)” has been published today. The […]

On October 1, 2018, AOPA submitted comments on a draft policy governing coverage of lower limb prostheses, including microprocessor-controlled prostheses issued by Health Care Services Corporation (HCSC), which operates Blue Cross Blue Shield of Illinois, Texas, Montana, New Mexico, and Oklahoma. The draft policy, as written will significantly reduce access to advanced prosthetic technology for […]

AOPA Submits Comments Regarding Improving the Medicare Gap Filling Process On September 10, 2018, AOPA submitted formal comments to CMS regarding suggestions on how to improve the “gap filling” process that is currently used to establish Medicare fee schedule amount for new HCPCS codes.  The opportunity to provide comments was the result of the annual […]

As many AOPA Members may already be aware, earlier this week, the Department of Veterans Affairs Office of Inspector General (VA OIG) issued a report regarding VA overpayments for prosthetic devices described by not otherwise classified (NOC) procedure codes. The full report may be accessed here. The key paragraph in the report addresses purported overpayment […]

O&P News Special Announcement The American Orthotic and Prosthetic Association (AOPA) continues its stride toward innovation by creating an online presentation and platform for O&P News. With an efficient website and click-ready flip-book, advertisers are more likely to garner viewership and gain exposure in the overall health-care arena. As always, AOPA strives to provide the […]