LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2013-08 Off-The-Shelf OTS Orthotics Codes Eff. 1 Jan 2014





On February 9, 2012, CMS issued initial guidance identifying specific Healthcare Common Procedure Coding System (HCPCS) codes that are considered Off-The-Shelf (OTS) orthotics and provided a 60-day comment period. CMS received approximately 185 comments. The comments have been thoroughly reviewed and CMS is now providing response to those comments. In addition, a final list of the 2014 codes identified as OTS orthotics is being codified. Section 1847(a)(2) of the Social Security Act (the Act) defines OTS orthotics as those orthotics described in section 1861(s)(9) of the Act for which payment would otherwise be made under section 1834(h) of the Act, which require minimal self-adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit to the individual. OTS Orthotics that are currently paid under section 1834(h) of the Act and are described in section 1861(s)(9) of the Act are leg, arm, back and neck braces. The Medicare Benefit Policy Manual (Publication 100-02), Chapter 15, Section 130 provides the longstanding Medicare definition of “braces.â€? Braces are defined in this section as “rigid or semi-rigid devices which are used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body.â€? CMS regulations at 42 CFR 414.402 also define the term “minimal self-adjustmentâ€? to mean an adjustment that the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and that does not require the services of a certified orthotist (that is, an individual who is certified by the American Board for Certification in Orthotics and Prosthetics, Inc., or by the Board for Orthotist/Prosthetist Certification) or an individual who has specialized training.To view the final list of 2014 OTS orthotic HCPCS codes, please visit theCMS Durable Medical Equipment Center web page and click on “OTS Orthotics” or CLICK-HERE TO SEE LIST