What's worse than a reduction in Medicare allowables?

What's worse than a reduction in Medicare allowables?

Joe Sansone

2/2/2009

How about denying coverage altogether? CMS decided that elastic
(neoprene, etc.) garments will no longer be covered. This applies to
spinal bracing as well. What this means for O&P providers is that we
will obviously face less reimbursement from all third party payers. But
perhaps it is a step in separating out custom vs. OTS and thereby
enabling O&P to differentiate itself from the drug store/ DME shops.
Who knows, if this mentality persists we may not have to worry about
competitive bidding for OTS products....... they will all be
non-covered.

 

 

 

For more information go to:
<URL Redacted>
< <URL Redacted>> .

 

 

Joe Sansone
C.E.O.
TMC Orthopedic
Amputee and Prosthetic Center
(713) 669-1800
www.myamputee.com < <URL Redacted>>
www.tmcortho.com < http://www.tmcortho.com >

 

The CMS determination applies to the following HCPCS codes: Effective
4/1/2009

 

L0210

Thoracic rib belt

L1800

Knee orthosis, elastic with stays, prefabricated

L1815

Knee orthosis, elastic or other elastic type material, with condylar
pads, prefabricated

L1825

Knee orthosis, elastic knee cap, prefabricated

L1901

Ankle orthosis, elastic, prefabricated

L3651

Shoulder orthosis, single shoulder, elastic, prefabricated

L3652

Shoulder orthosis, double shoulder, elastic, prefabricated

L3700

Elbow orthosis, elastic with stays, prefabricated

L3701

Elbow orthosis, elastic, prefabricated

L3909

Wrist orthosis, elastic, prefabricated

L3911

Wrist hand finger orthosis, elastic, prefabricated

L0450

TLSO, flexible, provides trunk support, upper thoracic region, produces
intracavitary pressure to reduce load on the intervertebral disks with
rigid stays or panel(s), includes shoulder straps and closures,
prefabricated

L0454

TLSO, flexible, provides trunk support, extends from sacrococcygeal
junction to above T-9 vertebra, restricts gross motion in the sagittal
plane, produces intracavitary pressure to reduce load on the
intervertebral disks with rigid stays or panel(s), includes shoulder
straps and closures, prefabricated

L0621

Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces
motion about the sacroiliac joint, includes straps, closures, may
include pendulous abdomen design, prefabricated

L0625

Lumbar orthosis, flexible, provides lumbar support, posterior extends
from L-1 to below L-5 vertebra, produces intracavitary pressure to
reduce load on the intervertebral disks, includes straps, closures, may
include pendulous abdomen design, shoulder straps, stays, prefabricated

L0628

Lumbar-sacral orthosis, flexible, provides lumbo-sacral support,
posterior extends from sacrococcygeal junction to T-9 vertebra, produces
intracavitary pressure to reduce load on the intervertebral disks,
includes straps, closures, may include stays, shoulder straps, pendulous
abdomen design, prefabricated