... it was necessary for the practitioner in the field to be able to employ any suitable strategy to maximize efficiency and remain profitable so that they could continue to service Medicare ’ s beneficiaries .
/// CMS UPDATE ///
HOW THAT DIRECTLY AFFECTS PEDORTHISTS
/// ESTABLISHMENT OF NEW HCPCS CODE FOR INSERTS FOR PATIENTS WITH DIABETES
CMS originally released a ruling that the language defining inserts for patients with diabetes that were allowable to be submitted for reimbursement through Medicare under the A5513 ( custom molded ) HCPCS code only included those fabricated by direct mold to the patient ’ s foot or over a positive model of the patient ’ s foot . The language did not allow for those that were scanned and fabricated through a CAD / CAM process where the insert was made directly from the digital image without the production of a positive model . Generally , this would be a system that milled out a core or shell that served as the base for the insert being dispensed . CMS went on to state that an insert produced in this fashion was not eligible for reimbursement under the A5512 ( off the shelf )
HCPCS code either . Instead , the insert must be coded as a non-covered device and would be considered ineligible for payment through Medicaid .
PFA contacted CMS and , along with several other sister organizations , expressed our disagreement with this ruling . There were several points to our position on this matter . The first was that there is no evidence that this technology , when properly used , produced a device that was inferior to one produced by other methods . Second , that with the low level of reimbursement for all of these devices it was necessary for the practitioner in the field to be able to employ any suitable strategy to maximize efficiency and remain profitable so that they could continue to service Medicare ’ s beneficiaries . Additionally , it seemed unreasonable for Medicare to encourage and embrace the same type of technology to
///
... it was necessary for the practitioner in the field to be able to employ any suitable strategy to maximize efficiency and remain profitable so that they could continue to service Medicare ’ s beneficiaries .
18 Pedorthic Footcare Association | www . pedorthics . org
///