With all of the different regulatory challenges and movements by payers to drive down reimbursements, even the slightest bit of good news can be reassuring. To that end, the 2014 Medicare DMEPOS fee schedule was released earlier this week and will actually increase reimbursement by about 1% for claims filed after January 1, 2014.
The updated 2014 fee schedule also includes about two dozen HCPCS codes that have been included in CMS’s definition of “off the shelf” (OTS) orthotics. At this point, there is no difference in reimbursement for the codes designated as OTS. However, CMS did update descriptions for the OTS codes and drew a distinction between products that are pulled off a shelf and provided to a patient, and those that are trimmed, molded or otherwise customized.
As a reminder, Phase II of PECOS will also activate in January 2014, on January 6th. As of January 6, O&P claims submitted where the referring physician is not properly enrolled in PECOS will be denied.