O&P-specific Codes for Billing Clinical Time Exist: Why Doesn’t O&P Use them?

Prosthetists and orthotists obtain advanced degrees, complete residencies, and pass board certification exams. They dedicate at least four years of post-graduate education to becoming clinically proficient in O&P for the safety and well-being of end users. Paradoxically, O&P clinicians, being relegated as suppliers of durable medical equipment, are only paid for delivering medical devices to patients, not for their clinical care.

It would be similar to an optometrist only being able to bill for contact lenses and not the exam. Or an OT only being able to bill for custom hand splints and not the evaluation and follow-up, or a PT only being able to bill for custom knee braces and not the rehab sessions. Wait, those last two hit a little too close to home: custom splints and braces? Aren’t those under the O&P practitioner’s scope of practice? Isn’t that just the situation that we are in? Physicians, OTs, and PTs could deliver a custom orthosis or prosthesis and bill for their clinical time and expertise along with the medical device, but instead they usually refer patients to a prosthetist/orthotist who has the necessary clinical expertise and specialized skill set.