All,
I have had an extensive conversation with CMS regarding the new codes and it was very enlightening. The conversation is too detailed to completely post. I have highlighted below the key areas of discussion.
My conversation ranged from why the codes were created to application by a person of expertise. Ultimately, it appears these codes were created for the following reasons:
* Created for the purpose to have new codes for competitive bidding
* What is considered a person of expertise
* Why the new codes get the same amount as the old codes
* What about PDAC
They have been trying to do something to stop mail order companies from just shipping these things to patients. This is their attempt. I understand but they should have just changed the process to say that orthotics must be applied and not mailed. They could have saved everyone a lot of hassle. I think they want mail order for the new codes under competitive bidding at a greatly reduced rate, say $200. Unfortunately, the beneficiary will be subject to one brace in five years. Therefore, if they get a brace coded L0642 for $100 from mail order, a normal supplier will not be able to give them a brace coded L0627 because of the five year rule. Feel free to call me on my cell phone at 610-587-1138 if you want to discuss in more detail. Hope this helps.
Steve Lusky
President
XBack Bracing Services
