US Politics
David Hendricks
Description
Collection
Title:
US Politics
Creator:
David Hendricks
Date:
6/12/2016
Text:
Dear O&P Colleagues:
This is a question regarding dual spinal L codes. Spinal codes used to describe the orthosis, then end with the phrase, includes fitting and adjustment.
Under the current regimen, effective beginning of 2014, the phrase, includes fitting and adjustment, was replaced with, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.
And a companion code was created, which replaces the above language with, prefabricated, off-the-shelf.
CMS has made it clear that the custom-fit language requires a fitting that includes a material alteration of the spinal orthosis which could not have been accomplished by anyone who is not an individual with expertise.
There are businesses who currently sell spinal braces to patients, ship them to the patients in a box, then bill Medicare and other third-party payers using the OTS (off-the-shelf) L code.
My question is: is what they do legal? That is, does the OTS code require a fitting? This would be a fitting not meeting the requirements of the custom-fit code, but one where a fitter physically fits the orthosis on the patient. It doesn't say such a fitting is required.
I'm not interested in hearing what we all think should be. I already know that. I want to know what is. Has CMS clarified this yet?
Thank you for your comments.
David Hendricks, CPO
Blue Diamond Orthopedic
Sent from my iPhone
This is a question regarding dual spinal L codes. Spinal codes used to describe the orthosis, then end with the phrase, includes fitting and adjustment.
Under the current regimen, effective beginning of 2014, the phrase, includes fitting and adjustment, was replaced with, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.
And a companion code was created, which replaces the above language with, prefabricated, off-the-shelf.
CMS has made it clear that the custom-fit language requires a fitting that includes a material alteration of the spinal orthosis which could not have been accomplished by anyone who is not an individual with expertise.
There are businesses who currently sell spinal braces to patients, ship them to the patients in a box, then bill Medicare and other third-party payers using the OTS (off-the-shelf) L code.
My question is: is what they do legal? That is, does the OTS code require a fitting? This would be a fitting not meeting the requirements of the custom-fit code, but one where a fitter physically fits the orthosis on the patient. It doesn't say such a fitting is required.
I'm not interested in hearing what we all think should be. I already know that. I want to know what is. Has CMS clarified this yet?
Thank you for your comments.
David Hendricks, CPO
Blue Diamond Orthopedic
Sent from my iPhone
Citation
David Hendricks, “US Politics,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/242311.
