The Centers for Medicare and Medicaid Services (CMS) announced that enhancements have been made to the Summary of Benefits and Coverage (SBC) template and Uniform Glossary of Medical Terms, also known as the Glossary of Health Coverage and Medical Terms. Included in the revised glossary is a definition of the term “orthotics and prosthetics” that is separate from durable medical equipment (DME). This document, which was established through provisions of the Affordable Care Act, is intended to provide guidance to private insurance companies when defining and establishing coverage for essential health benefits.
The glossary offers the following definition of orthotics and prosthetics:
Leg, arm, back and neck braces, artificial legs, arms, and eyes, and external breast prostheses after a mastectomy. These services include: adjustment, repairs, and replacements required because of breakage, wear, loss, or a change in the patient’s physical condition.
To access the glossary, visit www.healthcare.gov/sbc-glossary.