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

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