Correct Coding – Definitions Used for Off-the-Shelf, Custom Fitted and Custom Fabricated Orthotics (Braces) – Joint DME MAC Publication

As part of the January 2014 HCPCS update codes were created describing certain off-the-shelf (OTS) orthotics. Some of these OTS codes parallel codes for custom fitted versions of the same items. Refer to the table at the end of this article for a listing of codes.

When providing these items suppliers must:

• Provide the product that is specified by the ordering physician, i.e. (1) type of orthosis and (2) method of  fitting and/or fabrication (OTS, custom fitted or custom fabricated).
• Be sure that the medical record justifies the need for the type of product (prefabricated versus custom  fabricated)
• Have detailed documentation in your records that justifies the code selected (e.g., fabrication methods and materials used, appropriate level of fitting and credentials of the individual fabricating and fitting the item).  For the entire article and more information please click here CODES

Medicare & Medicaid Services (CMS) new “split” HCPCS (L‐Codes)

Dear Valued DJO Blog Followers,

We are writing in respect to the Centers for Medicare & Medicaid Services (CMS) new “split” HCPCS (L‐Codes) for certain types of orthotics. We have received many questions from our customers and thought that a written communication with our perspective on these recent changes might be helpful to you. Accordingly, we are pleased to provide you with the following documents:

(1) A DJO Compliance Bulletin that provides some background and rationale regarding these CMS coding changes;

(2) An “L Code Decision Tree” to guide you in determining whether to use an off‐the‐shelf (OTS) HCPCScode or a custom fitted (CTS) HCPCS code;

(3) A Clinical Documentation Template that incorporates the components outlined in the CMS DMEPOS Quality Standards, Appendix C. Please refer to these standards for the detailed requirements associated with billing a custom fabricated or custom fitted (CTS) orthotic.

For more information please click 2014 L Code Communication to DJO Customers 2 14   Supplier Clinical Documentation Template Sample