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News & Press: Government Affairs News

AAOE Members Secure Extended Comment Timeline for DMEPOS Proposal

Tuesday, November 27, 2018   (0 Comments)
Posted by: Bradley Coffey, MA, AAOE Government Affairs
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Indianapolis, IN - Members of the American Alliance of Orthopaedic Executives (AAOE) were instrumental in securing an extended public comment period on a proposal from the Centers for Medicare and Medicaid Services (CMS) to add off-the-shelf back and knee braces to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. For the past week, members have been sending letters to their members of Congress as well as CMS asking for an extension of the comment period and on Tuesday, November 27, CMS extended the deadline to December 17, 2018.

CMS' proposal would shift reimbursement for off-the-shelf back and knee braces from the current DMEPOS fee schedule to a reimbursement that is determined by competitive bidding. If this proposal is finalized, it would likely take effect when the Competitive Bidding Program resumes in December 2020.

In 2011, items included in the Competitive Bidding Program saw a reimbursement decrease of approximately 35%. If CMS adopts this proposal, physician suppliers and other suppliers of off-the-shelf back and knee braces could see their reimbursements tumble as much as 35%. The table below shows how these reimbursements could be affected for the codes identified by CMS as being moved to the Competitive Bidding Program assuming that they see a 35% reduction in their reimbursement value due to competitive bidding:

HCPCS Code

Description

DMEPOS Fee Schedule Ceiling for 2018

DMEPOS Fee Schedule Floor for 2018

 Reimbursement Ceiling Under Competitive Bidding  Reimbursement Floor Under Competitive Bidding

L0450

Tlso, flex trunk/thor pre ots

$210.29

$157.72

$136.69 $102.52

L0455

Tlso flex trnk sj-t9 pre ots

$400.94

$300.70

$260.61 $195.46

L0457

Tlso flex trnk sj-ss pre ots

$1,149.77

$862.33

$747.35 $560.51

L0467

Tlso r fram soft pre ots

$452.08

$339.06

$293.85 $220.39

L0469

Tlso rig fram pelvic pre ots

$554.65

$415.99

$360.52 $270.39

L0621

Sio flex pelvic/sacr pre ots

$111.58

$83.69

$72.53 $54.40

L0623

Sio rig pnl pelv/sac pre ots

$0.00

$0.00

$0.00 $0.00

L0625

Lo flex l1-below l5 pre ots

$63.70

$47.77

$41.41 $31.05

L0628

Lso flex no ri stays pre ots

$97.00

$72.75

$63.05 $47.29

L0641

Lo rig pos pnl l1-l5 pre ots

$90.13

$67.60

$58.58 $43.94

L0642

Lo sag ri an/pos pnl pre ots

$475.32

$356.49

$308.96 $231.72

L0643

Lso sag ctr rigi pos pre ots

$187.26

$140.45

$121.72 $91.29

L0648

Lso sag r an/pos pnl pre ots

$1,187.06

$890.30

$771.59 $578.70

L0649

Lso sc r pos/lat pnl pre ots

$331.59

$248.69

$215.53 $161.65

L0650

Lso sc r ant/pos pnl pre ots

$1,356.89

$1,017.66

$881.98 $661.48

L0651

Lso sag-co shell pnl pre ots

$1,356.89

$1,017.66

$881.98 $661.48

L1812

Ko elastic w/joints pre ots

$119.17

$89.38

$77.46 $58.10

L1830

Ko immob canvas long pre ots

$105.86

$79.39

$68.81 $51.60

L1833

Ko adj jnt pos r sup pre ots

$735.65

$551.74

$478.17 $358.63

L1836

Ko rigid w/o joints pre ots

$154.26

$115.69

$100.27 $75.20

L1848

Ko dbl upright w/air pre ots

$664.92

$498.69

$432.20 $324.15

L1850

Ko swedish type pre ots

$348.30

$261.22

$226.40 $169.79

L1851

Ko single upright prefab ots

$1,037.28

$777.96

$674.23 $505.67

L1852

Ko double upright prefab ots

$989.01

$741.76

$642.86 $482.14

 

Some AAOE members also received a survey to provide more information on the use of off-the-shelf back and knee braces at their practices. This information is important to AAOE as we work to provide CMS with data on the potential impact of their proposed policy change. If you received a survey invitation in your email, we encourage you to fill it out and provide us with the information we need to effectively advocate for you.

If you are interested in providing comments on behalf of your practice, check out AAOE's Tips for Writing an Effective Comment Letter and email advocacy@aaoe.net to get assistance from AAOE staff in drafting and submitting your comments.


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