Significant developments are occurring in the area of upper limb prosthetic coding administered by the Medicare program. In addition, we need to thank some key supporters of the George and Dena Breece Fellowship who helped make the 2024 Fellowship a success.

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The Breece Fellowship: Special thanks to the ABC Opportunity Fund and Cathy Carter, Executive Director of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics for shepherding through the NAAOP application for 2024 funding to support Taylor Haines, who completed her Fellowship in August. Taylor was an outstanding Fellow who brought great value to NAAOP this past summer, helping to draft key educational document on the So Every Body Can Move Campaign, assisting with organization of our virtual Congressional Fly-In, and promotion and presentation of our summer webinar on new Medicare coverage of MPK prosthetic knees for K-2 Medicare beneficiaries with limb loss. The ABC Opportunity Fund, as well as key NAAOP supporters and friends, made this year’s Fellowship happen, our seventh fellow since the start of the program, and we could not be more grateful for their support!

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Upper Limb Coding Improvements: NAAOP has been working closely with its O&P Alliance partners as well as the Upper Limb Society of the American Academy of Orthotists and Prosthetists on improving the HCPCS coding system for upper extremity prosthetics. In March, 2023, the Medical Directors of the DME Medicare Administrative Contractors retired a Medicare coding guidance document that was having the effect of limiting access to upper limb prosthetics for Medicare beneficiaries with partial hand, finger, and other upper limb amputations. The retirement of this guidance document came after concerted advocacy from NAAOP and the O&P Alliance.

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More recently, the Upper Limb Society, in collaboration with the O&P organizations, submitted a coding request to the CMS HCPCS Work Group to modify the description of 12 upper extremity codes to include the words “partial hand or finger” to each code, thereby explicitly allowing the use of these codes with partial hand and finger amputees. CMS responded recently, agreeing that the upper limb code set is outdated and in need of revision. Instead of adopting the 12-code modification proposal, however, CMS proposed to create seven new HCPCS codes to accommodate partial hand and finger amputees. Unfortunately, there are several problems with the CMS proposal such as confusion with respect to base codes, inappropriate recognition of the importance of both liners and flexible sockets for those requiring partial hand prostheses, and a number of questions regarding the pricing levels for these new codes.

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A preliminary hearing will be held at CMS on November 8th where the Upper Limb Society and O&P stakeholders will be able to comment on CMS’s proposal in hopes of either redirecting them to the original 12-code request, or improving the 7-code proposal from CMS. Stay tuned for more updates on upper limb coding as developments occur. Additional phases of this coding initiative are planned for the future and NAAOP will be engaged in each step of the process.

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Get Out The Vote: National elections are fast approaching. However you plan to vote, NAAOP encourages all of its members and friends to participate in the process and vote!​

 

Thank you to our members and please consider joining NAAOP to support our important policy and advocacy work for the O&P profession and the patients we serve.