BALTIMORE--Medicare posted more than 45 preliminary decisions answering requests for a host of targeted orthotics and prosthetics HCPCS codes on Wednesday. The agency also set a public meeting covering all of the requests for early next month.

"This is the first time we've had public involvement in the process," said Joe McTernan, assistant director of reimbursement services for the American Orthotics and Prosthetics Association. "This represents a much more open process. I was surprised; this wasn't something you'd see in the past."

O&P suppliers have faced a coding conundrum strikingly similar to problems in the mobility sector: the L codes for these products haven't reflected the latest technologies, leading--at least in part--to increased fraud and abuse from some "stock-and-bill providers that have used existing coding to bill beyond what's appropriate," said Pat Schelf, vice president of marketing and general manager of Ortho Rehab, a division of Otto Bock, Minneapolis.

So over the past several years, CMS has tweaked the codes to match available technology, starting with back bracing products in 2003. "The existing [new] codes have more anatomically-based descriptors," McTernan explained.

CMS announced plans to open up its coding application process for all DMEPOS following instructions from the agency's Council on Technology and Innovation, created by the Medicare Modernization Act, and recommendations from various industry groups. Those groups include the Coalitions of Wound Care, Respiratory Care and Seating and Positioning Manufacturers. Marcia Nusgart, the coalitions' executive director, said she had met with government officials over the coding issue for four years before CMS announced it would reform its HCPCS assignment process last November. The agency expects to implement further changes, including an appeals process, for the 2007 coding cycle.

"This is a giant step," Nusgart said last year in response to the announcement. The changes are "going to make the process a lot more understandable as well as transparent. We are very pleased that CMS responded to many of our recommendations."

The public meeting on the O&P code proposals will occur June 8 and 9 at CMS headquarters in Baltimore, and final coding changes will become effective Jan. 1. For more information, visit the CMS coding home page by clicking here.

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© 2007 Penton Media, Inc.