CMS updates O&P edits

Wednesday, May 28, 2014

BALTIMORE – CMS has instructed the DME MACs to update programming edits that deny claims for prosthetics and certain custom orthotics when they are furnished by personnel who are not certified orthotists or prosthetists in states where that is a requirement, according to a MLN Matters article. At the time of the original edit, in 2005, nine states had the requirement. Since then, eight additional states—North Dakota, Iowa, Pennsylvania, Arkansas, Georgia, Kentucky, Mississippi and Tennessee—have implemented the requirement. If a supplier is located in one of the 17 states with the requirement, it must be properly enrolled with the National Supplier Clearinghouse to ensure the correct specialty code(s) is on file. To view the official instruction, go here.