Correct Coding – Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) – Revised

As part of the 2014 HCPCS update codes were created describing certain off-the-shelf (OTS) orthotics. Some of these codes parallel codes for custom fitted versions of the same items. Refer to the appropriate Local Coverage Determination (LCD) for a list 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 (OTS or custom fitted)
• Be sure that the medical record justifies the need for the type of product and method of fitting
• Be sure only to use the code that accurately reflects both the type of orthosis and the appropriate level of fitting
• Have detailed documentation that justifies the code selected for custom fitted versus OTS codes)

The following definitions will be used for correct coding of these items.  Please click here for more information

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Categories: DME Coding, Medicare

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