On February 9, 2012, the Centers for Medicare & Medicaid Services (CMS) issued initial guidance identifying specific Healthcare Common Procedure Coding System (HCPCS) codes that are considered off-the-shelf (OTS) orthotics and provided a 60-day comment period. CMS said it received approximately 185 comments, which have been reviewed, and it has
provided responses to those comments.
In addition, a final list of the 2014 codes identified as OTS orthotics is being codified.
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. OTS 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.” Braces are defined in this section 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 (that is, an individual who is certified by the American Board for Certification in Orthotics, Prosthetics & Pedorthics or by the Board for Certification/Accreditation, International) or an individual who has specialized training.
To view the final list of 2014 OTS orthotic HCPCS codes, visit the CMS Durable Medical Equipment Center webpage and click on OTS Orthotics.
