AOPA Continues to Battle CMS Over Shoe Inserts

AOPA, as part of its work with the O&P Alliance, continues to battle CMS over shoe inserts.

Recently, CMS ruled that the SADMERC must review and approve prefabricated and custom-fabricated inserts before practitioners can bill for them. Manufacturers have to submit their inserts for a review process that can take several months, and patient care facilities have to verify that any inserts they purchase are on the Medicare-approved list.

AOPA has been fighting this ruling since December 2005, when CMS first announced this new policy. After the announcement, AOPA and the O&P Alliance were able to prevent CMS from immediately implementing this sweeping policy change, which was originally scheduled to go into effect Jan. 1, 2006. Instead, CMS delayed the policy until July 1, 2006.

As reported in the June 13 issue of AOPA In Advance, AOPA was successful in persuading CMS to remove O&P patient care facilities that fabricated their own inserts from this requirement. However, the CMS policy to require SADMERC review of all other prefabricated and custom inserts went into effect on July 1, 2006.  

AOPA and the O&P Alliance filed a complaint with CMS arguing that this policy and protocol are unnecessary. AOPA is concerned that this situation with shoe insert codes could set a precedent and spread to other codes or devices. Currently, AOPA is waiting to receive a response from CMS and will work with them until the issue is resolved.  

Keep on top of this and other coding, billing and reimbursement changes from Medicare by reading
the members-only e-mail newsletter AOPA In Advance. Send the e-mail addresses you wish to receive this newsletter, along with your AOPA member ID and street address, to Kim Striker at kstriker@AOPAnet.org.

If you’re not an AOPA member and want to receive the AOPA In Advance newsletter, contact Kelly O’Neill at koneill@AOPAnet.org or (571) 431-0852.