INDUSTRYNEWS
CMS Launches Redetermination Project Regarding A5513 Process
contours to the device. This is a total of three
transfers, during any of which the human element
can cause deviation, loss of detail or error. Having
the scan of the foot used to produce the shell of the
device directly eliminates one of those transfers
of the contour which logically can only serve to
increase accuracy. Additionally, CMS’ assertion
that this is the case seems incongruous with the
fact that they find this same technology acceptable
when reimbursing for prostheses whose sockets are
increasingly being manufactured on 3D printers.
There seems to be no issues with the fact that these
devices, with their highly complex shapes and
requisite extraordinarily intimate fit, are produced
with no physical casts. Sockets produced in this
fashion have produced excellent results.
PFA encourages all of our Vendor Members that
hold current PDAC approval letters to get their
applications for reassessment submitted as soon
as possible. PDAC estimates that it will take
approximately 90 days for them to process each
application. Given the fact that they are now going
to get flooded with applications, that time frame
is likely to rise. For our Regular Members, keep in
close contact with your suppliers. In the meantime,
PFA will be utilizing the platform of the seats we
hold on the CMS Regional Councils to try to force
the LCD to be reexamined so that our patients
can benefit from access to the most advanced
technology available. After all, do the patients
deserve less? -PFA
Figure 2: PDAC Website - Medicare Pricing, Data Analysis and Coding
References: 1. DME MAC Joint Publication article:
https://www.cgsmedicare.com/articles/cope3771.html
2. CMS Pricing, Data Analysis and Coding (PDAC):
https://www.dmepdac.com/dmecsapp/do/productsearch?resultsColl_p_=1&policyGro
up=160&manufacturer=&productsearchsubmit.y=15&productsearchsubmit.x=16&pro
ductName=&hcpcsCode=A5513&modelNumber=
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Pedorthic Footcare Association www.pedorthics.org