AOPA's Efforts Lead to New Liner HCPCS Codes

AOPA's Efforts Lead to New Liner HCPCS Codes

AOPA

8/14/2002

AOPA In Advance (AIA)
Special Edition - August 14, 2002
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AOPA's Efforts Lead to New Liner HCPCS Codes
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AOPA won a hard-fought victory when the Centers for Medicare and Medicaid
Services (CMS) recently announced its intention to establish four new
temporary Medicare K codes for prefabricated and custom-fabricated liners.
The new Healthcare Common Procedure Coding System (HCPCS) codes will become
effective on Oct. 1, 2002. In October of last year, CMS announced that it
would delete the code used for roll-on silicone gel liners -- L5669:
Addition to lower extremity, below knee/above knee, socket insert, suction
suspension without locking mechanism -- and the field was directed by CMS to
use L5660 and L5662-L5664 instead.

AOPA disagreed with this approach and argued that L5660 and L5662-L5664
represented older technology, which was not comparable to the soft roll-on
liners most commonly used today. AOPA took immediate action because AOPA
believed that using these old codes with their significantly lower
allowables, particularly for custom-fabricated liners, would adversely
affect the quality of care delivered to Medicare beneficiaries. Under the
CMS scenario, practitioners would be forced to go back to earlier, less
satisfactory technology.

The creation of these new liner codes was the direct result of AOPA's
regulatory and legislative lobbying efforts to build an effective coalition
of practitioners and liner manufacturers. AOPA has a strong relationship
with CMS staff, and we made sure Medicare officials were aware of our
concerns, said Kathy Dodson, AOPA's senior director of government
relations.

Scott Schneider, president of TEC Interface Systems, said, TEC is pleased
that through the liner coalition put together by AOPA, CMS recognized liner
technology was not adequately represented by using the old codes following
the elimination of L5669. We believe that if AOPA had not intervened on
behalf of the industry, practitioners would have had far less access to our
state-of-the-art products as well as liners produced by other
manufacturers.

Ohio Willow Wood President Robert Arbogast stated, AOPA is to be commended
for the diligent and successful effort they undertook in clarifying the
enormous value that this (liner) technology brings to the amputee, the
actual victor in this compromise. Continued cooperation between AOPA and CMS
is vital...

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The descriptors for the new K codes announced by CMS are as follows:

K0556 - Addition to lower extremity, below knee/above knee, custom
fabricated from existing mold or prefabricated, socket insert, silicone gel,
elastomeric or equal, for use with locking mechanism.

K0557 - Addition to lower extremity, below knee/above knee, custom
fabricated from existing mold or prefabricated, socket insert, silicone gel,
elastomeric or equal, not for use with locking mechanism.

K0558 - Addition to lower extremity, below knee/above knee, custom
fabricated socket insert for congenital or atypical traumatic amputee,
silicone gel, elastomeric or equal, for use with or without locking
mechanism, initial only (for other an initial, use code K0556 or K0557).

K0559 - Addition to lower extremity, below knee/above knee, custom
fabricated socket insert for other than congenital or atypical traumatic
amputee, silicone gel, elastomeric or equal, for use with or without locking
mechanism, initial only (for other than initial, use code K0556 or K0557).

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Medicare reimbursement rates for these new K codes have not yet been made
public. To read the entire CMS Program Memorandum in Transmittal AB-02-104
dated July 31, 2002, access:
<URL Redacted>

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American Orthotic & Prosthetic Association T 571.431.0876
330 John Carlyle St, Ste 200 F 571.431.0899
Alexandria, VA 22314 www.aopanet.org

For more information, email us: <Email Address Redacted>
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