On February 9, 2012, the Centers for Medicare & Medicaid Services (CMS) issued guidance that initially identifies specific Healthcare Common Procedure Coding System (HCPCS) codes that are considered off-the-shelf (OTS) orthotics.
Section 1847(a)(2) of the Social Security Act (SSA) defines OTS orthotics as those orthotics described in section 1861(s)(9) of the SSA for which payment would otherwise be made under section 1834(h) of the SSA, which require minimal self-adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit to the individual. Orthotics that are currently paid under section 1834(h) of the SSA and are described in section 1861(s)(9) of the SSA are leg, arm, back, and neck braces.
The Medicare Benefit Policy Manual (Publication 100-02), Chapter 15, Section 130, provides the longstanding Medicare definition of “braces” as “rigid or semi-rigid devices which are used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body.” CMS regulations at 42 CFR 414.402 also define the term “minimal self-adjustment” to mean an adjustment that the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and that does not require the services of a certified orthotist or an individual who has specialized training.
The list of OTS orthotic HCPCS codes are on the CMS website. Comments on the OTS list of codes may be submitted to CMS via e-mail to OTSComments@cms.hhs.gov, through Thursday, March 8, 2012.
