Hello list, I had a question asked today by a patient
and I can say that I trufully don’t know the
answer. “What kind of >doctor can make a prescription
for a prosthesis or an orthosis?” Can any body help me
with this? Are there any >restrictions to specialties?
John S. Stewart LP, CP Naples Prosthetics and
Orthotics, Inc
Any MD or DO can prescribe orthoses or prostheses as
well as any Clinical Nurse Practitioner or Physician’s Assistant with State prescriptive authority. Chiropractors with State authorized prescriptive authority can write prescription for orthoses or prostheses. So, in a nutshell nationwide DO’s and MD’s can write; other health care professionals may be granted as a matter of state licensure and law the prescriptive authorization to prescribe.
Per Medicare…any physician except podiatrists and chiropractors, regardless of specialty.
It is my understanding any licensed medical doctor can
write the script, however I may be incorrect so please
post your responses.
In the majority of states it requires an MD…any kind
of MD, no speciality is required, it could be an OGBYN
or a family practitioner, as long as it is an MD. Some
states allow a Physicians Assistant to write an RX. Be
advised however, regardless of the state regulation, the
payor may have yet another requirement, ie; a specific referring physician. Rule of thumb is to ensure it is an MD.
Any M.D. and many times a DPM. Probably the best choice
is a PM&R, Ortho, Neuro, Surgeon or other specialty
working with the disability you are dealing with, but
many times a G.P. is totaly adequate.
Any kind of doctor with MD behind their name. The Rx is
for payment by insurance, Medicare, and etc. but is NOT required by law. It is legal for anyone to fit a prosthesis or orthosis except where there is state law such as Florida, Texas, Illinois and a few others. However, if you are certified by ABC you could loss your certification if you fit without an Rx. It would be OK for your technician, secretary, mother-in-law, or janitor if they are not affiliated with ABC and not in a state with a license requirement.
To the best of my knowledge, any doctor that can sign MD
or DO after his name can sign a prescription. I can not
quote chapter and verse of Medicare guide lines, but I
have never been questioned about a doctor’s right to
prescribe a prosthesis or orthosis except when a primary
care physician is involved with a HMO patient. Hope this
helps
Physiatrists are the main ones. They are specialists in physical medicine and rehabilitation. Prosthetics and orthotics is a part of their residency training (at least in Canada). They are the primary physician supervising the rehabilitation of tertiary care rehab facilities in Canada.
any MD can write the rx then when we receive the rx for
a device we mail them back a specific rx for them to
sign after the eval…this lists EACH component
used…makes it easier foe reimbursements.
Any MD, DO or podiatrist.
In my opinion the first specialist who can prescribe it properly is the orthopaedic surgeon. Orthotics precisely related with spine and affected neurology are the common domain of neurosurgeon and orthopedic surgeon. However, consultants in physical medicine and general surgeons practicing with the ailments of locomotor systems come the second. Next follow the Paediatric surgeons and physicians. Physiotherapists are the allied professionals and get referral for physio only similarly as Orthotists and prosthetists get it for them to do the job.
As far as I know there are no restrictions to an extent
as long as they are in a practice reasonable to provide
such a prescription. However, you must take into
consideration the differences in insurance companies and
what they require. Medicaid must have an orthopaedic
doctor prescribing in order to pay for prosthetics and orthotics.
To the best of my knowledge, any M.D. or D.O. can
prescribe a prosthesis.
I have not seen or read any if there are restrictions. I
cannot provide you with actual verbiage, though. I don’t
think I would feel comfortable with a podiatrist writing
my Rx for a new Prosthesis, though, even if there is not specific verbiage that limits it. I had one patient ask me if his psychologist could write the Rx (just for prosthetic socks). He certainly could, but I would not accept it. Again, I don’t know if it’s specifically written that this cannot occur, but I sure wouldn’t want to fight a Medicare audit with a questionable Rx! Since it’s general practice that the Prosthetic/Orthotic facility generates the Rx and the MD signs off on it, any MD with basic knowledge of the patient and prescribed device would suffice. But YOU should feel comfortable with the specialist. I think I would be very careful here and only accept a Rx from a “qualified O&P” physician (i.e. orthopedist, internist, surgeon, and of course GP’s). In my opinion, I would prefer the patient wait and see a qualified MD and get a proper Rx rather than ME have to deal with questionable circumstances in the future.
