April 2018 NAAOP Update: O&P Policy Round Up

Victory on Diabetic Foot Orthoses

March witnesses a decision from the Center for Medicare and Medicaid Services (CMS) to retain the same reimbursement level for diabetic foot orthoses that are digitally scanned and fabricated through additive manufacturing as foot orthoses that are physically molded to a patient model.  This is a major decision that sets a very positive precedent for more than twenty other orthotic L-codes where technology has permitted these new manufacturing techniques to replace traditional fabrication methods.  The decision relies on the following explanation:  “The fees for code K0903 are set based on the fees for code A5513 because inserts carved from a digitized scan of the patient’s foot were determined to be comparable to inserts made over a positive model of the patient’s foot.”  A5513 is the existing billing code for diabetic foot orthoses using traditional methods whereas K0903 is the newly-established billing code for diabetic foot orthoses that are manufactured using digital scanning technology.

 This positive conclusion resulted from coordinated and proactive efforts by a number of O&P organizations including AOPA, the O&P Alliance organizations, the Amputee Coalition and the American Podiatric Medical Association.  NAAOP was pleased to have participated in these efforts and believes the decision bodes well for future coding and payment decisions involving innovative manufacturing techniques used in the O&P field.

Omnibus Spending Bill Omits Healthcare Provisions

 The O&P Policy Forum hosted by AOPA was well timed this year as Congress prepared to pass an Omnibus Spending bill to fund the federal government through the end of Fiscal Year 2018.  NAAOP joined over 100 members of the O&P community in sending a strong message to Capitol Hill to include in that bill two major provisions, implementation of BIPA Section 427 which links Medicare payment with O&P practitioner qualifications, and clarification of the term “minimal self-adjustment” which defines off-the-shelf orthotics that are subject to competitive bidding.

 The $1.3 trillion bill finally passed and was signed into law on March 23rd.  Many health care organizations worked hard during February and March to include a wide variety of health care provisions in this legislative vehicle.  The O&P community was one of them.  In the end, Congress could not agree to include a bipartisan bill to stabilize the Affordable Care Act’s individual insurance markets and, once this provision of the bill was not included, virtually all of the other health care provisions were also omitted from the bill.  The O&P provisions were left out of the bill along with dozens of other non-O&P healthcare provisions that were under consideration by Congress.  NAAOP will continue working with its Alliance partners to eventually pass these provisions, hopefully in the next legislative vehicle that addresses health care issues.  

David McGill
President