The Centers for Medicare & Medicaid Services (CMS) issued Transmittal 1385 on May 16, which lists three additional states that require the use of a licensed or certified orthotist or prosthetist to furnish O&P devices. These states are North Dakota, Iowa, and Pennsylvania. The effective date is March 3, and the implementation date is June 17, 2014.
This transmittal is based on Change Request (CR) 8390, which instructs the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) to revise programming edits so that these three additional states are added to the logic, in accordance with CR 3959 (originally issued on August 19, 2005). CR 3959 instructed DME MACs to implement claims processing edits to ensure compliance with state regulations that require durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers who wish to bill Medicare to operate their business and furnish Medicare-covered items in compliance with all applicable federal and state licensure and regulatory requirements.
Other states on the list are: Alabama, Arkansas, Florida, Georgia, Illinois, Kentucky, Mississippi, New Jersey, Ohio, Oklahoma, Rhode Island, Tennessee, Texas, and Washington.