AOPA Gains New Codes

The American Orthotic and Prosthetic Association (AOPA) "won a hard-fought victory" when the Centers for Medicare and Medicaid Services (CMS) recently announced its intention to establish four new temporary Medicare K-Codes for prefabricated and custom fabricated liners, AOPA announced August 15 in an online posting of the "AOPA in Advance" news bulletin.

The new Healthcare Common Procedure Coding System (HCPCS) codes will become effective on Oct. 1, 2002, AOPA said. In October of last year, CMS announced that it would delete the code used for roll-on silicone gel liners-L5669: Addition to lower extremity, below knee/above knee, socket insert, suction suspension without locking mechanism-and the field was directed by CMS to use L5660 and L5662-L5664 instead.

AOPA disagreed with this approach and argued that L5660 and L5662-L5664 represented older technology, which was not comparable to the soft roll-on liners most commonly used today, according to "AOPA in Advance." AOPA took immediate action because the association believed that using these old codes with their significantly lower allowables, particularly for custom-fabricated liners, would adversely affect the quality of care delivered to Medicare beneficiaries, the newsletter stated, adding, "Under the CMS scenario, practitioners would be forced to go back to earlier, less satisfactory technology."

"The creation of these new liner codes was the direct result of AOPA's regulatory and legislative lobbying efforts to build an effective coalition of practitioners and liner manufacturers," the publication said. "AOPA has a strong relationship with CMS staff, and we made sure Medicare officials were aware of our concerns," said Kathy Dodson, AOPA's senior director of government relations, quoted in the newsletter.

Scott Schneider, president of TEC Interface Systems, quoted in the publication, said, "TEC is pleased that through the liner coalition put together by AOPA, CMS recognized liner technology was not adequately represented by using the old codes following the elimination of L5669. We believe that if AOPA had not intervened on behalf of the industry, practitioners would have had far less access to our state-of-the-art products as well as liners produced by other manufacturers."

Ohio Willow Wood President Robert Arbogast, also quoted by "AOPA in Advance," stated, "AOPA is to be commended for the diligent and successful effort they undertook in clarifying the enormous value that this (liner) technology brings to the amputee, the actual victor in this compromise. Continued cooperation between AOPA and CMS is vital."

The descriptors for the new K codes announced by CMS are, according to AOPA:

K0556 - Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism. K0557 - Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism. K0558 - Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other an initial, use code K0556 or K0557). K0559 - Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code K0556 or K0557). Medicare reimbursement rates for these new K codes have not yet been made public, AOPA noted. To read the entire CMS Program Memorandum in Transmittal AB-02-104 dated July 31, 2002, access: http://www.hcfa.gov/pubforms/transmit/AB02104.pdf The use of K-Codes were clarified by Kathy Dodson, AOPA's senior director of government affairs, in an online post August 15: "... because an item is designated as a K-Code, that does not mean it has been deemed a DME item. K-Codes are simply DMERC [Durable Medical Equipment Regional Carrier] temporary codes that are used to allow code changes to be made mid-year or outside the formal annual L-Code review process.

"There are currently K codes for everything from drugs to wheelchair armrests," Dodson continued. Usually K codes are later turned into HCPCS codes that more formally categorize the type of service or device, she explained. "For example, in 2000, the K-Code K0401, deluxe feature for therapeutic shoes, was turned into A5508. It is likely that at some point in the future, our new K liner codes will be turned into L-Codes." She added, "In addition, the fact that these liners are currently designated as K-Codes has no effect on payment or benefit category."

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