CMS Has Not Promulgated Regulations to Establish Payment Requirements for Prosthetics and Custom-Fabricated Orthotics. Executive Summary.

摘要

Prosthetics and orthotics are covered under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Medicare benefit. In 2010, CMS allowed $276 million in Medicare payments for 257,797 prosthetic and custom-fabricated orthotic claims (excluding accessories, additions, and other supplemental prosthetic and orthotic items). Industry representatives have asserted that unqualified practitioners and suppliers are furnishing and/or fabricating Medicare-paid prosthetics and custom-fabricated orthotics. These representatives are concerned that unqualified practitioners and suppliers, who lack necessary training and education, are providing substandard custom-fabricated items to Medicare beneficiaries. Additionally, a 2000 Office of Inspector General (OIG) report concluded that qualifications of orthotic suppliers varied, with noncertified suppliers being the ones most likely to provide inappropriate items and services. OIG has not specifically reviewed the qualifications of practitioners and suppliers of prosthetics and custom-fabricated orthotics previously.