American Orthotic & Prosthetic Association

AOPA In Advance

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December 27, 2004
SPECIAL EDITION

2005 Coding Alert: New Allowables Released
The Centers for Medicare and Medicaid Services (CMS) has just released the allowables for some of the new 2005 L codes that go into effect Jan. 1, 2005.  The fees for codes that carried over from 2004 will remain unchanged, since the fee schedule for O&P did not increase.  In addition, a chart of the new allowables is available for download.  To view the chart, click here.* To download the entire DMEPOS fee schedule for 2005, click here.*

Good News for O&P
There is a direct crosswalk for the codes for the micro-processor knee in 2005.  Therefore, the allowable for the new L5856 is the same as the sum of the 2004 allowables for L5846, L5847 and L5989.  There is also a direct crosswalk for the new allowable for L5857, which replaces L5846 and L5989. 

Some Fees Not Yet Released
According to CMS, a number of new codes have not been priced and the DMERCs are still developing these allowables.  Until their release, any new codes without allowables will be individually priced ("Individual Consideration").  Once the DMERCs establish the allowables, they will go into effect April 1, 2005.

AOPA Billing Tips for "Individual Consideration"
Keep in mind that whenever the DMERCs pay for an "Individual Consideration (IC)" item, the more information you provide, the more likely you are to receive adequate reimbursement.  Therefore, in addition to indicating your charge, describe the device in detail, including materials used, time needed to fabricate, method of fabrication, and for prefabricated devices, the manufacturer and make/model.  You may also want to provide material costs in an effort to help the DMERC determine a price.  If you cannot fit this information in the HAO record on the electronic claim, you may want to submit a paper claim instead. 

Questions?  Contact Joe McTernan at jmcternan@AOPAnet.org, or (571) 431-0876, ext. 211.  You may also contact Virginia Torsch at vtorsch@AOPAnet.org, or (571) 431-0876, ext. 212.

New Year, New Codes: Attend AOPA Coding & Billing Seminar
Is your facility ready to begin billing the new HCPCS codes in 2005?  Ensure your entire billing staff is billing correctly–attend one of the upcoming AOPA Coding & Billing Seminars:

• February 15-16 in Las Vegas (The Mirage) or
• April 20-21 in Columbus, OH (Hyatt Capitol Square)

AOPA experts will explain and simplify the complexities of coding and billing in an interactive setting.  Explore the basics of reimbursement, the latest in coding changes, and how to avoid fraud and abuse situations. 

Register early and save!  Seminar registration is $525 members ($725 non-members) when you register before the early bird deadlines: Jan. 14 for Las Vegas and Mar. 28 for
Columbus, OH!  To register, visit www.AOPAnet.org or call AOPA at (571) 431-0876, ext. 201.