The Centers for Medicare & Medicaid Services (CMS) has announced a 0.8 percent fee schedule increase for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), effective for claims with a date of service on or after January 1, 2013.
Further, 2013 fees for several Healthcare Common Procedure Coding System (HCPCS) labor payment codes will be increased by 1.7 percent, effective for dates of service on or after January 1, 2013, through December 31, 2013. Affected L-Codes specific to O&P are L-4205 (repair of orthotic device, labor component, per 15 minutes) and L-7520 (repair of prosthetic device, labor component, per 15 minutes).
The fee schedule amount for the one new O&P-specific L-Code, L-5859 (addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)), which is effective January 1, 2013, will be established as part of the July 2013 DMEPOS Fee Schedule Update, when applicable. Also when applicable, Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will establish the local fee schedule amount to pay claims for the new code from January 1, 2013, through June 30, 2013.
For gap-filling purposes, the 2012 deflation factor for prosthetics and orthotics is 0.482.
The fee schedule amounts for certain shoe modification codes are being revised, effective January 1, 2013, to reflect more current allowed service data. The affected codes and their short descriptions are listed below:
- A-5503 – diabetic show w/roller/rockr
- A-5504 – diabetic shoe with wedge
- A-5505 – diab shoe w/metatarsal bar
- A-5506 – diabetic shoe w/off set heel
- A-5507 – modification diabetic shoe
