Medicare Competitive Bidding AnnouncemeNT

All Medicare Round 2021 Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program (CBP) Contracts for Off-the-Shelf (OTS) back braces and OTS knee braces expire on December 31, 2023. Starting January 1, 2024, there will be a temporary gap in the DMEPOS CBP.

The Centers for Medicare & Medicaid Services plans to conduct bidding for the next round of the DMEPOS CBP after going through notice and comment rulemaking to further strengthen the DMEPOS CBP.

For additional information on the gap period, please see the Temporary Gap Period (PDF) fact sheet and continue to monitor the and Competitive Bidding Implementation Contractor (CBIC) websites for updates.

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CMS Competitive Bidding

durable medical equipment, prosthetics,orthotics and supplies (dmepos) order requirements

On January 17, 2023, a second Federal Register Notice was published that announced 10 additional orthoses that will require a face-to-face encounter and written order prior to delivery as a condition of payment. Therefore, effective April 17, 2023, a total of 63 items are now on the face-to-face encounter and written order prior to delivery List.

Standardized DMEPOS Written Order/Prescription

Any Medicare provider or supplier that writes DMEPOS orders or prescriptions will now use a standard set of elements that will be applicable to all DMEPOS items.

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) Number
  • Description of the item
  • Quantity, if applicable
  • Treating practitioner name or National Provider Identifier (NPI)
  • Date of the order
  • Treating practitioner signature

The treating practitioner must submit the complete written order to the supplier prior to submitting a claim for Medicare payment.

For more information please click here.

A successful 2023 starts with ensuring your clinic or ASC has the best DME SaaS technology

Healthcare leaders recognize patients as their most important area of focus. At the same time, however, overseeing business needs like inventory management, reimbursement, price transparency and staff shortages are top priorities. Significant opportunities exist for orthopedic clinics and ASCs to leverage automation to address these issues – but choosing the right solution can be daunting. 

For more information, please click here to read the entire Becker’s article

Providing Orthoses Prior to Surgery – Reminder

CGS wants to remind suppliers and providers that orthotic devices are not covered if they do not meet the coverage criteria outlined in the Local Coverage Determinations (LCDs) for the HCPCS code prescribed at the time of service.

Devices provided prior to the start of medical necessity (for example, before the surgery), will not meet the coverage criteria. After surgery, if there is documentation of the medical necessity for the orthotic device(s), you can provide the item, keeping in mind there are many other payment rules related to the claim.

For orthotic devices that require Prior Authorization (PA) (L0648, L0450, L1832, L1833, and L1851), do not submit PA requests prior to the start of medical necessity (for example, before the surgery). After surgery, if the medical record documentation shows an emergent need for the device(s), you can submit an expedited request. If an expedited request is not feasible, append the ST modifier to the claim to bypass PA. Claims submitted with the ST modifier are subject to 100% prepayment review.

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AAOE Adds MotionMD® by DJO® Software Platform to the Peer Review Program™ for Orthopedic and Musculoskeletal Vendors

The American Alliance of Orthopaedic Executives (AAOE) adds the MotionMD® software platform by DJO® to the Peer Review Program™ for orthopedic and musculoskeletal vendors, connecting members with industry professionals. The AAOE Peer Review Program™ has been established to evaluate vendors of orthopedic products, services, and solutions. Approved vendors have demonstrated a strong reputation for advancing orthopedic practice objectives.

Please click this link for more information.  AAOE MotionMD