Physicians Billing for Off the Shelf Braces in a Competitive Bid Area

Competitive Bidding, Round 2021 will take effect on January 1, 2021. This round includes off the shelf knee and back braces. Only the winning bidders in a specific geographical area are able to provide these braces to Medicare beneficiaries. The exception to this rule is physicians and PTs/OTs may provide the braces to their patients as part of the treatment.

What Does This Mean for You?

• Make sure you know if you are in a Competitive Bid Area. To determine if a ZIP Code is in a CBA, enter it in the “FIND A CBA” tool on the tool bar at the top of the page at http://www.dmecompetitivebid.com.
• If you bill and OTS back brace or OTS Knee Brace, you must still meet all the medical necessity requirements outlined in the LCD.
• When billing for one of the OTS braces, use the modifier “KV” in addition to any other modifiers required per the LCD.
• The claim is sent to the appropriate DME MAC.
• The date of service on the claim must be the same date you bill for professional services to the Part A/Part B intermediary.
• You will be paid according to the Competitive Bid rates established for the particular code.

Here is a list of the HCPCScovered under Competitive Bid, Round 2021