The Centers for Medicare & Medicaid Services (CMS) is hosting its first public meeting to get reactions about Healthcare Common Procedure Coding System (HCPCS) preliminary coding of products, supplies and services, Medicare benefit categories, and Medicare payment determinations. The virtual public meeting will be held June 7-10.
The agenda for the first two days of the public meeting includes Medicare benefit category and Medicare payment determinations for items and services described by new HCPCS Level II codes established from 2020 to 2022 as well as additional items added by CMS to address Medicare benefit category or payment determinations. The agenda for the remaining days includes requests for new revisions to the HCPCS code set.
According to Össur R&R, the company’s reimbursement-related newsletter, the following preliminary benefit category and payment determination decisions are related to O&P:
- The workgroup designated L-2006 as part of the leg brace (orthotic) benefit category and set a preliminary average fee schedule amount of $33,810. The predicate device for which L-2006 was created is Ottobock’s C-Brace.
- The workgroup designated K-1014 as part of the artificial leg (prosthetic) category and set a preliminary average fee of $6,463.27. The predicate device for which K-1014 was created is Proteor’s ALLUX knee.
- The workgroup designated K-1022 as part of the artificial leg (prosthetic) category and set a preliminary average fee of $676.08. The predicate device for which K-1022 was created is Ottobock’s 4R57 Rotation Adapter.
- The predicate device for which K-1007 was created is the ReWalk Exoskeleton System. The workgroup declined to classify K-1007 as part of the leg brace benefit category or to provide a preliminary fee schedule determination. Until additional guidance is issued, the DME MACs will have discretion to cover and pay for items described by K-1007.
- The predicate device for which L-8701 was created was the Myomo MyoPro. The workgroup declined to classify L-8701 as part of the arm brace (orthotic) benefit category or to provide a preliminary fee schedule determination. Until additional guidance is issued, the DME MACs will have discretion to cover and pay for items described by L-8701.
“With pricing now in the HCPCS Coding Workgroup’s domain, this will be the first time that discussions about the perceived adequacy/inadequacy of the fees themselves and the underlying methodology used to arrive at them will happen in public,” Össur said in its newsletter. “We would expect direct feedback from applicants and other stakeholders regarding preliminary pricing decisions, especially for those products listed above for which the applicants believe the preliminary pricing is too low.”
To see the daily agendas for the meeting, visit the CMS website under HCPCS Public Meetings.
