CMS has issued its transmittal to accompany the 2014 DMEPOS fee schedule update at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2013-Transmittals-Items/R2836CP.html?DLPage=1&DLSort=1&DLSortDir=descending). The reimbursement update factor this year is 1%. The transmittal includes a discussion of specific coding and pricing issues, including policies regarding the new off-the-shelf (OTS) orthotic codes. CMS confirms in the transmittal that the 2014 fee schedule amounts for existing codes will be crosswalked to the corresponding new codes added for the items furnished OTS, so the reimbursement is the same for the new OTS codes as it is for the existing codes.
Please be aware that CMS also notes that “Section 1847(a)(2)(C) of the Act mandates implementation of competitive bidding programs throughout the United States for awarding contracts for furnishing off-the-shelf (OTS) orthotics which require minimal self-adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit the individual.” The transmittal, however, does not provide any further detail in respect to when CMS might subject orthotics to competitive bidding.
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