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Important Information for Iowa Providers Of Off-the-Shelf Orthotics

Posted on in VGM News

Attention: Iowa DMEPOS

On January 1, 2014 a change occurred with some HCPCS codes that may have affected Iowa DMEPOS licensure. If you provide Off-the-Shelf Orthotics (OTS), you need to check the following HCPCS codes as some have split into two codes. The MLN Matters article can be found here. For example, if you provided HCPCS code L0627 as an OTS product, as of January 1, 2014 the OTS HCPCS code is L0642 and L0627 is the custom-fitted code. codes-graphic

Here are the definitions of OTS orthotics and custom-fitted orthotics

Off-the-shelf (OTS) orthotics are:
  • Items that are prefabricated
  • They may or may not be supplied as a kit that requires some assembly. Assembly of the item and/or installation of add-on components and/or the use of some basic materials in preparation of the item does not change classification from OTS to custom fitted.
  • OTS items require minimal self-adjustment for fitting at the time of delivery for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit an individual.
  • This fitting does not require expertise of a certified orthotist or an individual who has equivalent specialized training in the provision of orthoses to fit the item to the individual beneficiary.
Custom fitted orthotics are:
  • Devices that are prefabricated
  • They may or may not be supplied as a kit that requires some assembly. Assembly of the item and/or installation of add-on components and/or the use of some basic materials in preparation of the item does not change classification from OTS to custom fitted.
  • Classification as custom fitted requires substantial modification for fitting at the time of delivery in order to provide an individualized fit, i.e., the item must be trimmed, bent, molded (with or without heat), or otherwise modified resulting in alterations beyond minimal self-adjustment.
  • This fitting at delivery does require expertise of a certified orthotist or an individual who has equivalent specialized training in the provision of orthosis to fit the item to the individual beneficiary.

If you have received a letter from the National Supplier Clearinghouse (NSC) that has the information:

crf.424.57c Here is what you need to do:
  1. If you have a valid pedorthist, orthotist, or prosthetist license, then just submit the licensure and any other necessary information to the address on the letter.
  2. If you are not licensed to provide that service, then submit a letter on company letterhead to the address indicated on the letter with a plan of action. State in the letter what error occurred and how that error will be fixed so it doesn’t occur again.
The update to the license can be found on the NSC’s website at www.palmettogba.com. Here is the information: B - Effective 1/1/2014, the Iowa Board of Podiatry established the rules to license Orthotists, Prosthetists, and Pedorthists. The licenses are not required of health care practitioners licensed in this state such as physicians, registered nurses, physical therapists, occupational therapists, chiropractors, and pharmacists who engage in the profession or occupation for which they are licensed. For more information, please view the Practice Act including exemptions at https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.148F.pdf. Here is a link to the licensure database on the NSC websites, once you are on that page, click on the DMEPOS State Licesure Directory, then select Iowa see to the requirements. For any further questions, please contact the Reimbursement Team.
Ronda Buhrmester Dan Fedor
Respiratory, Face to Face ruling, general DME and NSC Power and Complex Rehab, prior authorization and ADMC
(888) 665-6518 - Work (570) 499-8459 - Work
(855) 252-3821 - Fax (844) 307-5729 - Fax
Ronda.Buhrmester@vgm.com Dan.Fedor@vgm.com

 

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