Providing O&P Items in a Licensure State
There are 17 states currently requiring licensure to provide custom fabricated and custom-fit orthotic and prosthetic devices:
- Alabama
- Arkansas
- Florida
- Georgia
- Illinois
- Iowa
- Kentucky
- Mississippi
- New Jersey
- North Dakota
- Ohio
- Oklahoma
- Pennsylvania
- Rhode Island
- Tennessee
- Texas
- Washington
In these states, a licensed/certified orthotist/prosthetist MUST provide the custom fabricated or custom-fit O&P device. There are a few exceptions: physicians, physical therapists, occupational therapists, and other state-specific specialties.
If you practice in one of the above states and wish to bill Medicare for custom or custom-fit O&P items, you need to be properly enrolled with the National Supplier Clearinghouse (NSC.) Effective October 1, 2021, CMS will implement new claims edits to determine the appropriate personnel is providing the service. If you are not correctly registered with the NSC, your claim may be denied.
What does this mean for you?
If you are not currently registered as a DMEPOS supplier, contact the NSC and request Form CMS-855S.
If you are currently registered and practice in one of the above listed states, contact the NSC to assure your specialty codes are listed correctly.
You may read the full article from CMS here.
To enroll as a DMEPOS provider, follow the instructions on this site.
For assistance in determining your current licensure status, call NSC Customer Service at 866-238-9652.