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David McGill Blogger

O&P Separated From DME in the Uniform Glossary

Posted by David McGill | April 12, 2016

The Affordable Care Act expands coverage to millions of Americans through health care exchanges that offer individuals and small businesses private insurance. In order to help educate consumers about these policies, the ACA requires private insurers to provide consumers clear information about their health plan benefits and coverage. One way they do this is via the Uniform Glossary of Coverage and Medical Terms, a collection of standard definitions.

The Uniform Glossary is maintained and updated by Medicare, even though its use is in the private insurance space. And last week for the first time, the Uniform Glossary separated the term "orthotics and prosthetics" from "durable medical equipment​."

What does this mean for you?

It is important to understand that even though Medicare maintains and updates the Uniform Glossary, the separation of the terms "orthotics and prosthetics" and "durable medical equipment" in that document does not mean that the Medicare program itself has separated those benefits. Rather, this definitional change applies to private plans offered through the Affordable Care Act.

Second, while the Uniform Glossary does not specifically apply to Medicare, it does provide the O&P profession another argument in support of its longstanding contention that O&P and DME are very different from each other. We therefore anticipate the Uniform Glossary update proving useful in future discussions with Medicare agencies and officials.

Click here​ to see the Uniform Glossary's definition of "orthotics and prosthetics."

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