OPTUM NP'S

Well, it looks as though CMS has released the fee schedule for 2015.  Below listed are a few notes.

1. There is a 1.5% increase from the  2014 Fee Schedule.

2. The bifurcated OTS orthotic codes schedule mirrors the Pre Fabricated Custom Fit “with                                                                                Expertise” schedule.

Example:

L0631     $987.92 (AL-Custom Pre Fab)                          L0648    $987.92 (AL-OTS)

L1832    $725.49 (AL-Custom Pre Fab)                            L1833    $725.49 (AL-OTS)

L3807    $219.01 (AL-Custom Pre Fab)                            L3809    $219.01 (AL-OTS)

 

What does this mean?  Barring any mid-year or end of year 2015 retro-active changes, supplying OTS product will generate the same levels of revenue as the PreFab “fit with expertise”.  This does seem understandable, since CMS tabled the final ruling for a description of “one with expertise”.  What i think this also means is CMS will be looking at including these OTS codes for Round 2 of Competitive Bidding in July of 2016.

 

Here is a link to the complete 2015 Fee Schedule

Copy of DME2015_Jan_V1120 Fee Schedule