NAAOP Comments on O&P Prior Authorization

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The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released a statement about the February 11 announcement by the Centers for Medicare &Medicaid Services (CMS) that six lower-limb prosthetics Healthcare Common Procedure Coding System (HCPCS) codes will be subject to prior authorization as a Medicare condition of payment (L-5856, L-5857, L-5858, L-5973, L-5980, and L-5987).

NAAOP said it has previously expressed concerns regarding the application of prior authorization to orthoses and prostheses because "unlike durable medical equipment, which is largely commodity based, prosthetic care is clinical in nature and service oriented. Prior authorization has the potential to interfere with the provision of timely and appropriate care."

The president's fiscal year 2021 budget contains a proposal to expand prior authorization to all Medicare fee-for-service items and services. However, NAAOP notes, CMS Administrator Seema Verma seemingly contradicted the president's proposal when she said at the American Medical Association National Advocacy Conference that "prior authorization requirements are a primary driver of physician burnout, and even more importantly, patients are experiencing needless delays in care that are negatively impacting the quality of care they receive." She also stated in that speech that "prior authorization became indefensible years ago," and she planned to reform or restrict prior authorization this year. The inconsistent message strikes a discordant tone as CMS implements prior authorization of these six prosthetic codes, NAAOP concluded.