AOPA and its lobbying team have been pressing CMS from all levels, most recently including consultation with Trump Administration officials at the Office of Management and Budget, to formally implement the provisions of Section 50402 of the Bipartisan Budget Act of 2018 (Public Law 115-123) as it related to the prosthetistâ€™s and orthotistâ€™s clinical notes.
AOPA was encouraged bythe DME MAC notification 2-3 weeks ago where the DME MAC Medical Directors announced that they were â€˜retiringâ€™ the August 2011 â€œDear Physicianâ€ letter on Lower Limb Prosthetics.
AOPA would like to share a recent letter from Alec Alexander, CMSâ€™ Director of Program Integrity, that indicates that CMS â€œhas issued instruction to the Durable Medical Equipment (DME) Medicare Administrative Contractors (MAC) to implement Section 50402 immediately.â€
Section 50402 states:
â€˜â€˜(5) DOCUMENTATION CREATED BY ORTHOTISTS AND PROSTHETISTS.â€”For purposes of determining the reasonableness and medical necessity of orthotics and prosthetics, documentation created by an orthotist or prosthetist shall be considered part of the individualâ€™s medical record to support documentation created by eligible professionals described in section 1848(k)(3)(B).â€™â€™.
Mr. Alexanderâ€™s letter is a clear assertion of CMSâ€™ commitment to acknowledge immediate implementation of the new statutory provisions in Section 50402, accepting the orthotist and prosthetist clinical notes as part of the individualâ€™s medical record as to â€œdetermining the reasonableness and medical necessity of orthotics and prostheticsâ€ e.g., functional levels, identification of broken, damaged parts and their repair, and identifying components in a category included in a physician approved detailed written order. We also suggest that AOPA members consider including a copy of the letter with all claims they file.
We will continue to keep you informed of any developments in this important area.
The letter from Mr. Alexander and the DME MAC announcement regarding the retirement of the Dear Physician letter for lower limb prostheses may be viewed on AOPA’s website atÂ http://www.aopanet.org
AOPA’s Take.Â Where You Go……When You Need to Know!!!