• News New Blog Banner

  • CMS Shelves Controversial Orthotics and Prosthetics Proposal

    The US Centers for Medicare and Medicaid Services (CMS) has killed a controversial proposal that would have restricted many physical therapists (PTs) from furnishing custom orthotics and prosthetics. The proposal was opposed by APTA and a host of other provider and patient advocacy organizations.

    The proposed rule, issued in January, would have required PTs to be "licensed by the state [as a qualified provider of prosthetics and custom orthotics], or…certified by the American Board for Certification in Orthotics and Prosthetics…or by the Board for Orthotist/Prosthetist Certification." The association voiced its opposition to the CMS plan, characterizing the proposal as a set of unnecessary requirements that would limit patient access to appropriate care.

    The March 13 deadline for comments passed, and CMS issued no further communication on the proposal until last month, when a notice that the proposal was being withdrawn from the White House Office of Management and Budget’s “Unified Agenda” indicated that the proposal was no longer under active consideration by CMS. On October 3, notice that the proposal would be officially withdrawn appeared in the Federal Register, with the withdrawal document itself scheduled to be published the next day.

    The withdrawal represents a win for thousands of PTs who would have been saddled with significant additional regulatory and financial burdens in order to qualify as a provider. In addition to its direct comments to CMS, APTA's advocacy efforts included meetings with CMS and the creation of a template letter to be used by many members to voice their individual opposition to the proposal.


    • Thank you for fighting for the PTs that invest lots of time in fabricating and modifying foot orthotics to help relieve pain and encourage proper positioning.

      Posted by Andrea Evans on 10/3/2017 2:26 PM

    • I thought we had to have a DME number in order to be reimbursed by Medicare for orthotics.

      Posted by marilyn kovar on 10/5/2017 8:10 AM

    • From a PT who teaches splint making for wrist and hand, I am grateful to all who steeped up to fight this.

      Posted by Kevin Lawrence on 10/5/2017 1:21 PM

    • 😕 So much misinformation! BIPA 2000 was mandated by Congress, yes back in 2000, in response to CMS concerns that thousands of providers (mostly DME) were using custom coding improperly and driving up utilization for devices. CMS was to define who was qualified to provide "Custom" orthotic and prosthetic devices for the purposes of providing these services to CMS beneficiaries within 1 year! The intent was never to limit a PT or OT's ability to provide devices they were trained and qualified to provide. Foot orthosis are not even part of the benefit. Orthotist and prosthetists do not support the concept of limiting ALL orthotic and prosthetic devices to only Orthotist and prosthetists -only those devices that are custom designed and fabricated. This is strikingly similar to PT's opposition to Physician-owned PT practices, where physicians can use lesser qualified providers to provide and bill for PT services without the oversite and regulation covering practices owned by PTs. This is about quality patient care; insuring that only persons properly educated and qualified are allowed to provide care. To oppose this and support the efforts against physician-owned PT practices is hypocritical. Regardless of the terminal degree status of the PT and OT professions, PT and OT curriculums do not provide the course of study to allow them to provide and service custom orthosis and prostheses as required by statutes, and most PTs and OTs do not possess the training after graduation to do so. Those that do should be regulated the same as any other provider. This is sad, we should have worked together on this to support it and then used the momentum to regulate physician-owned practices of any sort that are outside the specialty and scope of the owner/provider. This was an opportunity lost and a defeat for quality care for CMS beneficiaries, not to mention a windfall for the thousands of unqualified DME providers who continue to practice outside the scope of their education and expertise.

      Posted by Jim Rogers, CPO, FAAOP on 10/6/2017 2:24 PM

    • So does this mean we can bill L3020?

      Posted by Erica Kellner on 10/9/2017 8:51 AM

    • Erica, Regardless of whom "we" refers to, perhaps understanding what procedures are covered benefits by CMS would be a good start: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS-Items/2017-Alpha-Numeric-HCPCS-File.html A quick look into the covered services for Medicare Beneficiaries would demonstrate that no provider (regardless of whether they are qualified to provide care) will be reimbursed for L3020.

      Posted by Chris Robinson on 4/21/2018 11:55 AM

    Leave a comment
    Name *
    Email *