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Tag: Orthotic braces

Ashlie White

Specialty Providers

O&P stakeholders work relationships

April 29, 2022Theresa Flaherty, Managing Editor

WASHINGTON – Stakeholders commend CMS for improvements to the recently implemented prior authorization program for five orthosis codes, but they continue to press the agency to address concerns related to direct-to-consumer shipping of certain devices.   While a nearly year-old PA program for lower limb prosthetics has been successful, stakeholders feared that the two-day turnaround for approval for orthotics would delay care, says Joe McTernan, director of coding and reimbursement...

American Orthotic & Prosthetic Association, Orthotic braces

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CMS addresses urgent need for orthotics 

April 18, 2022HME News Staff

WASHINGTON – CMS has published a FAQ for situations when patients need orthotic braces earlier than the two-day expedited timeframe. The agency says providers need to bill claims for L0648, L0650, L1832, L1833 and L1851 in these situations with the ST modifier and they will not undergo prior authorization. In a competitive bidding area, they need to bill these claims with the modifiers KV, J5 or J4, along with the ST modifier. Starting April 13, L0648, L0650, L1832, L1833 and L1851 were...

Orthotic braces, Prior authorization

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DOJ charges two in $25M scheme

November 29, 2021HME News Staff

NEWARK, N.J. – Two Florida men have been indicted for their roles in DME and compound medication schemes involving kickbacks and fraud, the Department of Justice and the U.S. Attorney’s Office for the District of New Jersey have announced. Thomas Farese of Delray Beach, Fla., and Domenic Gatto of Palm Beach Gardens, Fla., are charged in an 11-count indictment with conspiracy to commit wire fraud, conspiracy to commit health care fraud, conspiracy to transact in criminal proceeds, transacting...

Medicare fraud, Orthotic braces

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Two charged in $109M brace scheme 

January 22, 2021HME News Staff

BOSTON – Two women have pleaded guilty to charges they participated in a scam to defraud Medicare of more than $109 million by filing false claims for orthotic braces. Jessica Jones, 30, of Louisville Colo., and Elizabeth Putulin, 30, of Coconut Creek, Fla., who have each pleaded guilty to one count of conspiracy to commit health care fraud, conspired with their employer, Juan Camilo Perez Buitrago, to submit more than $109 million in false and fraudulent claims for DME, such...

Medicare fraud, Operation Brace Yourself, Orthotic braces

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OIG issues mid-year update

June 8, 2016HME News Staff

WASHINGTON - Power mobility devices and orthotic braces are among the product categories under review by the Office of Inspector General, according to a new report.The OIG released its Mid-Year Update for 2016 on June 7.Necessary and compliantThe OIG will perform several reviews to determine whether claims were medically necessary and compliant with Medicare requirements. Affected product categories include orthotic braces, nebulizers and related drugs, and power mobility devices.System editsThe...

OIG work plan, Orthotic braces, Power mobility devices

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