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David McGill Blogger

Three Things ....

Posted by David McGill | November 18, 2014


Here are three recent things you should know that may affect (but probably won't profoundly change) your reimbursement life in 2015:

1. 2015 O&P Coding Update

CMS released its 2015 HCPCS coding update. 

  • Codes L0625 L6025, L7260, and L7261 will be deleted effective January 1, 2015.
  • 3 new codes will be effective on January 1: L0626 L6026 (transcarpal/metacarpal/partial hand prosthesis), L7259 (electronic wrist rotator), and L3981 (upper extremity fracture orthosis, humeral). For complete descriptions of each code, please click here.
  • CMS modified the descriptor for code L7367. It now reads "Lithium ion battery, rechargeable replacement."

2. 2015 Fee Schedule Update

The question that invariably follows the announcement of the annual coding update is "Where's the 2015 fee schedule?" Medicare typically releases the fee schedule for the upcoming year sometime in December. We will issue a post when that happens.

3. The OIG 2015 Workplan

The OIG released its 2015 Workplan. It contains substantively identical language to the 2014 Workplan:

We will review Medicare Part B payments for claims submitted by medical equipment suppliers for lower limb prosthetics to determine whether the requirements of CMS's Benefit Policy Manual [ ] were met. A national OIG review of suppliers of lower limb prosthetics identified 267 suppliers that had questionable billing. Earlier OIG work found that suppliers frequently submitted claims that did not meet certain Medicare requirements; were for beneficiaries with no claims from their referring physicians; and had other questionable billing characteristics (e.g., billing for lower limb prostheses for a high percentage of beneficiaries with no history of amputations or missing limbs. Such claims are questionable and, if determined to be improper, should not be paid by Medicare​. Payments to service providers are precluded unless the provider has and furnishes upon request the information necessary to determine the amounts due.

What does this mean for you?

You should review the 2015 code deletions and additions and prepare to start billing consistent with them beginning on January 1. 

In addition, the 2015 Workplan suggests that OIG will continue to give priority to scrutinizing prosthetic claims over the next 12 months. Review the prosthetic Local Coverage Determination and accompanying Policy Articles before year-end to ensure that your claims comply with these requirements.

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