In the world of O&P billing, we are conditioned to expect a clear hierarchy: More clinical labor equals higher reimbursement. Since 2014, CMS has reinforced this by differentiating between off-the-shelf (OTS) and custom-fitted prefabricated items. The logic is simple: If patients can fit a brace themselves with minimal adjustment, the reimbursement is lower because the practitioners’ expertise isn’t “taxed.”
However, a closer look at the current fee schedule for AFOs reveals a head-scratching anomaly regarding codes L-1932 (AFO, rigid anterior shell, prefabricated, includes fitting and adjustment) and L-1933 (AFO, rigid anterior shell, prefabricated, OTS).
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