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  • Proposed CMS Rule Would Reduce Prosthetics, Orthotics, Other DME Reimbursement; APTA Posts Summary

    A Centers for Medicare and Medicaid (CMS) proposed rule (.pdf) could reduce reimbursement for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) by more than $7 billion from 2016 through 2020, largely through applying payment rates from the DMEPOS competitive bidding program in noncompetitive bidding areas. APTA has published a detailed "highlights" summary of the rule on the DMEPOS webpage, part of a suite of APTA resources on Medicare payment.

    Additional proposed policies that would impact physical therapists (PTs) include:

    • In 12 competitive bidding areas (CBAs), CMS would provide payment on a continuous monthly rental basis for certain items (including standard manual wheelchairs, standard power wheelchairs, and hospital beds). This payment would cover the item and ongoing maintenance and servicing, as well as replacement of supplies.
    • Where payment is made in a competitive bidding program (CBP) on a capped rental basis, CMS would require contract suppliers for power wheelchairs to retain responsibility for all necessary repairs, maintenance, and servicing of any power wheelchairs they furnish under the CBP.
    • CMS would identify PTs as “individuals with specialized training” to provide custom-fitted orthotics.

    The public will have until September 2, 2014, to submit comments on the rule, and APTA will submit comments on behalf of its members.

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