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David McGill Blogger

Medicare Proposes Inclusion of Some Orthotics in Competitive Bidding

Posted by David McGill | November 06, 2018

​Medicare posted an announcement on its website yesterday seeking comments on a new proposal that would include off-the-shelf knee and spinal orthoses in the next round of competitive bidding. The specific codes in play are:

  1. Knee Orthoses: L1812; L1830; :1833; L1836; L1848; L1850; L1851; and L1852.

  2. Spinal Orthoses: L0450; L0455; L0457; L0467; L0469; L0621; L0623; L0625; L0628; L0641; L0642; L0643; L0648; L0649; L0650; and L0651.

What does this mean for you?

If these items are included in the competitive bidding program, it means that only suppliers awarded competitive bidding contracts would be permitted to dispense them to Medicare beneficiaries. It is also possible that physicians could be in some way exempted from certain aspects of the competitive bidding program, though that is speculation only at this point. In addition, the competitively-bid fees for these OTS orthoses would be lower than the current Medicare fee schedule.

Medicare recently announced that there will be a two-year gap in the competitive program beginning in January of 2019 and lasting through 2020. As a result, the most likely scenario is that if these OTS orthoses are included in the next round of competitive bidding, the enrollment/contracting process would start sometime in the middle of/late 2019 so that they could be included in "Round 2021" of the competitive bidding program. (Medicare has historically started the enrollment/contracting process roughly 18 months before the contracts go into effect.)

If you would like to comment on the potential inclusion of these OTS knee and spinal orthoses in the competitive bidding program, you have until December 3rd to do so. You can submit your comments to [email protected] and your subject line must state "Competitive Bidding Product Categories."

We will keep you apprised of further developments regarding this issue as we get additional information.

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