The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released its latest webcast in which Peter W. Thomas, JD, general counsel for NAAOP, discusses improvements to upper-limb coding, and the 2024 summer George and Dena Breece fellowship.
The Breece Fellowship: Thomas gave special thanks to the ABC Opportunity Fund and Cathy Carter, executive director of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics for shepherding through the NAAOP application for 2024 funding to support Taylor Haines, the seventh fellow since the program began, who completed her fellowship in August. Thomas said Haines was an “outstanding fellow who brought great value to NAAOP this past summer.” She helped to draft a key educational document on the So Every BODY Can Move campaign, assisting with organization of its virtual Congressional Fly-In, and promotion and presentation of its summer webinar on new Medicare coverage of microprocessor knees for K2 Medicare beneficiaries with limb loss.
Upper-limb Coding Improvements: NAAOP has been working closely with its O&P Alliance partners and the Upper Limb Society of the American Academy of Orthotists and Prosthetists on improving the Healthcare Common Procedure Coding System (HCPCS) for upper-limb prostheses. In March, 2023, the Medical Directors of the Durable Medical Equipment (DME) Medicare Administrative Contractors retired a Medicare coding guidance document that was having the effect of limiting access to upper-limb prostheses for Medicare beneficiaries with partial hand, finger, and other upper-limb amputations. The retirement of this guidance document came after concerted advocacy from NAAOP and the O&P Alliance, Thomas said.
More recently, the Upper Limb Society, in collaboration with the O&P organizations, submitted a coding request to the Centers for Medicare & Medicaid (CMS) HCPCS Work Group to modify the description of 12 upper-limb codes to include the words “partial hand or finger” to each code, thereby explicitly allowing the use of these codes for people with partial hand and finger amputations. CMS responded recently, agreeing that the upper-limb code set is outdated and in need of revision, Thomas said. Instead of adopting the 12-code modification proposal, however, CMS proposed to create seven new HCPCS codes to accommodate individuals with partial hand and finger amputations. Unfortunately, Thomas said, there are several problems with the CMS proposal such as confusion with respect to base codes, inappropriate recognition of the importance of both liners and flexible sockets for those requiring partial hand prostheses, and a number of questions regarding the pricing levels for these new codes.
A preliminary hearing will be held at CMS on November 8, where the Upper Limb Society and O&P stakeholders will be able to comment on CMS’s proposal in hopes of either redirecting them to the original 12-code request, or improving the seven-code proposal from CMS. More phases of this coding initiative are planned for the future and NAAOP will be engaged in each step of the process, Thomas said.
To view a recording of the webinar, visit NAAOP’s website.
To watch the latest NAAOP webcast, visit its YouTube page.
