Orthotic codes list 'off base'

BALTIMORE - It's been more than a year in the making, but industry stakeholders are still puzzled by CMS's finalized list of off-the-shelf (OTS) orthotics.

“We think the list is way, way off-base,” said Tom Fise, executive director of the American Orthotics and Prosthetics Association. “This is extremely inconsistent with the statutory definition of what is OTS.”

The list is meant to clarify what constitutes OTS orthotics. Providers aren't required to have special certification for OTS, which is defined as any item that can be used by the patient with minimal self-adjustment.

The biggest source of confusion: Several of the products on the list will have two codes, one for when the product is OTS, one when it's custom fitted.

“It's not clear who makes the decision on whether or not to use the OTS or custom-fitted code,” said Wendy Miller, director of facility accreditation for BOC. “If the supplier uses the custom code and they don't have the appropriate documentation from the physician, that's going to leave them open to audits.”

Having two codes will be further complicated if OTS orthotics are included in a future round of competitive bidding, says Fise.

“If a patient goes to an orthotist who says, 'This doesn't need fitting,' does the orthotist then send that patient away?” he said. “Do they have the patient fill out an advance beneficiary notice? Does the orthotist acquire devices from a contract supplier and keep them in the closet? It's mind boggling the things they haven't considered.”

Providers also need to be mindful of state regulations governing who can provide orthotics, such as OTs, says Kelly Wolfe.

“CMS is giving the green light to provide these items,” said Wolfe, president of Regency Billing and Consulting. “You still have to follow your state guidelines.”

To view the list, go here.