CMS New List of Orthotics to be considered OTS
Bremer Group
Description
Collection
Title:
CMS New List of Orthotics to be considered OTS
Creator:
Bremer Group
Date:
2/17/2012
Text:
If something wasn’t ‘imminent’*, It seems unusual that CMS would publish a new OTS Orthotics list, <URL Redacted>, “for comment” by March 8, 2012. OTS “Off the Shelf” used to mean no service, no billing, no fitting, no adjusting or no follow up was included. CMS has muddied the waters as to that meaning of OTS by the publication of this list. OTS used to mean the patient could purchase the product, without a prescription, and fit it on themselves.
There are three traditional categories for orthotics:
1.. Off the Shelf – no service to patient, sale of item only.
2.. Custom Fitted/Prefabricated – orthotic service needed to fit premade orthoses to customize or assemble from components on the patient then to fit, adjust and follow up the patient in the orthosis fit on them.
3.. Custom Made to patient model –fabricate orthosis from raw materials to the patient’s model, process accompanied by the orthotic services needed for fitting, adjusting and following up the patient in the custom made orthosis.
This OTS list from CMS ignores these past limitations as to what is OTS. Many of the codes listed are for braces that require service by trained healthcare personnel, who select, order, and customize the brace to fit the patient according to the prescription, then follow the patient’s progress in the brace, and modify the brace as needed. This OTS list might as well have been comprised by the GAO(Gov’t Acctg Office), trying to eliminate the cost of orthotic service requiring patient contact, service and follow up in order to meet cost-cutting goals, not to accomplish what’s in the patient’s best interest. With a click of the mouse, prefabricated is now labeled OTS.
When the original HCPCS codes were developed, fee schedules for these items (requiring fitting, adjustment and follow-up) envisioned and included amounts for the services needed to accompany these items. Unlike the CPT codes used to bill for service by other healthcare professionals, Orthotists cannot use CPT codes to bill for their services. Orthotists have always been reimbursed for their services in conjunction with the braces they provide. Orthotists and Prosthetists furnish service, product and value for which they receive compensation. This compensation covers costs, payrolls, overhead, professional expenses, insurance and hopefully some profit. Without compensation for their product and services, orthotic companies and individuals can’t survive and grow.
The Competitive Bidding process was designed to reduce costs and was limited by law to orthotics that are OTS. These items were described as requiring “minimal self-adjustment.” The last time I checked, minimal self-adjustment did not mean fitting by the “supplier of the device” as they may not even be present with or see the patient. When is “self” a supplier? Does this supplier, (self), meet the requirements of CMS for records, facility accreditation criteria, follow up, billing, etc.? CMS’ attempt to add these new, mostly custom fit/ prefabricated, codes to the OTS list would reduce their reimbursement for them to the lowest bid, not by established fee schedule, and would not reimburse any service because, by definition, there is none.
Ladies and Gentlemen, the camel has more than his nose under the tent. Comment now to CMS at <Email Address Redacted> about what they are attempting to label OTS or lose these codes to the internet or some mail order provider! DME MAC C is already publishing this list as fact. Remember the Social Security Act defines the law. CMS Regulations are not serving the patient’s best interest by changing the meaning of “the law”, without the benefit of Legislature’s involvement. We have until March 8, 2012 to comment – DO IT NOW!
Sincerely,
Ross L. Bremer, CPO, LPO
* Interim Report on CMS Orthotic Listing Released Last Week: 2/13/2012, AOPA
There are three traditional categories for orthotics:
1.. Off the Shelf – no service to patient, sale of item only.
2.. Custom Fitted/Prefabricated – orthotic service needed to fit premade orthoses to customize or assemble from components on the patient then to fit, adjust and follow up the patient in the orthosis fit on them.
3.. Custom Made to patient model –fabricate orthosis from raw materials to the patient’s model, process accompanied by the orthotic services needed for fitting, adjusting and following up the patient in the custom made orthosis.
This OTS list from CMS ignores these past limitations as to what is OTS. Many of the codes listed are for braces that require service by trained healthcare personnel, who select, order, and customize the brace to fit the patient according to the prescription, then follow the patient’s progress in the brace, and modify the brace as needed. This OTS list might as well have been comprised by the GAO(Gov’t Acctg Office), trying to eliminate the cost of orthotic service requiring patient contact, service and follow up in order to meet cost-cutting goals, not to accomplish what’s in the patient’s best interest. With a click of the mouse, prefabricated is now labeled OTS.
When the original HCPCS codes were developed, fee schedules for these items (requiring fitting, adjustment and follow-up) envisioned and included amounts for the services needed to accompany these items. Unlike the CPT codes used to bill for service by other healthcare professionals, Orthotists cannot use CPT codes to bill for their services. Orthotists have always been reimbursed for their services in conjunction with the braces they provide. Orthotists and Prosthetists furnish service, product and value for which they receive compensation. This compensation covers costs, payrolls, overhead, professional expenses, insurance and hopefully some profit. Without compensation for their product and services, orthotic companies and individuals can’t survive and grow.
The Competitive Bidding process was designed to reduce costs and was limited by law to orthotics that are OTS. These items were described as requiring “minimal self-adjustment.” The last time I checked, minimal self-adjustment did not mean fitting by the “supplier of the device” as they may not even be present with or see the patient. When is “self” a supplier? Does this supplier, (self), meet the requirements of CMS for records, facility accreditation criteria, follow up, billing, etc.? CMS’ attempt to add these new, mostly custom fit/ prefabricated, codes to the OTS list would reduce their reimbursement for them to the lowest bid, not by established fee schedule, and would not reimburse any service because, by definition, there is none.
Ladies and Gentlemen, the camel has more than his nose under the tent. Comment now to CMS at <Email Address Redacted> about what they are attempting to label OTS or lose these codes to the internet or some mail order provider! DME MAC C is already publishing this list as fact. Remember the Social Security Act defines the law. CMS Regulations are not serving the patient’s best interest by changing the meaning of “the law”, without the benefit of Legislature’s involvement. We have until March 8, 2012 to comment – DO IT NOW!
Sincerely,
Ross L. Bremer, CPO, LPO
* Interim Report on CMS Orthotic Listing Released Last Week: 2/13/2012, AOPA
Citation
Bremer Group, “CMS New List of Orthotics to be considered OTS,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/233343.
