AOPA Confirms K0903 Medicare Fee Schedule at Same Rate as A5513


Recently, AOPA announced an important Advocacy victory regarding the Medicare fee schedule amount for K0903, the newly created HCPCS code used to describe direct milled, custom fabricated diabetic inserts.  When K0903 was first announced, CMS indicated that the Medicare fee schedule would be approximately $5.00 less than the current fee schedule for A5513 which describes custom fabricated diabetic inserts molded over a positive model of the patient’s foot.  AOPA challenged this position and presented several arguments that supported the direct crosswalk of the Medicare fee schedule for A5513 to the fee schedule for K0903.

Last week, AOPA announced that CMS had issued a bulletin indicating that the fee schedule for K0903 would be set at $43.56, the current Medicare fee schedule for A5513.  CMS has released the Medicare fee schedule update for April 1, 2018 and AOPA has confirmed that the Medicare allowable for K0903 has indeed been established at $43.56, the identical fee schedule amount for A5513.

AOPA is proud of this advocacy victory, not only for what it represents for providers of diabetic inserts, but also for the precedent that it sets for future issues involving the use of scanning and other technology to create alternate manufacturing processes in orthotics and prosthetics.

Questions regarding this issue may be directed to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.