The New York State Department of Health Office of Health Insurance Programs included an increase to the Medicaid O&P fee schedule in its 2022-2023 budget. The budget will increase reimbursement for the top 20 O&P codes to 80 percent of Medicare rates, and establish higher reimbursement to O&P providers for the top 20 O&P codes to enhance access to O&P for Medicaid members. The change was implemented for claims as of April 1.
The 2022-2023 budgeted fee structure for the O&P codes will be comparable to Medicare and other third-party insurers. The change is expected to have an impact of $3.75 million in the state in 2022-2023 and 2023-2024.
The rate had “remained relatively unchanged for the past 30-plus years,” according to the state chapter of the American Academy of Orthotists and Prosthetists.