STATE BY STATE
Updates on Cranial Orthoses, Prior Authorization, and More
P Co-O e h t t i Vis test the la e e s to nd OPA a A m o fr ers memb r e h t o 9. VID-1 O C n o Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more.
Update on Reimbursement for Cranial Orthoses
In a clear policy win for O&P, BlueCross BlueShield has issued a revised policy, DME 103.007, “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses,” effective March 1, 2020, in five states: Illinois, Montana, New Mexico, Oklahoma, and Texas. The updated policy addresses many of the concerns AOPA expressed in its policy review request submitted following the Nov. 1, 2019, published policy. Visit the AOPA Co-OP for additional information.
Prior Authorization for Prostheses
Initial implementation of prior authorization for six prosthetic codes is scheduled for May 2020 in Pennsylvania, Michigan, Texas, and California, with nationwide implementation scheduled for late 2020. The six codes that will require Medicare prior authorization are L5856, L5857, L5858, L5973, L5980, and 5987. The selected codes represent three microprocessor-controlled prosthetic knees, a microprocessor-controlled prosthetic foot, and two functional Level 3 prosthetic feet. (See Reimbursement Page on page 18 for details on the planned rollout of prior authorization.) 56
APRIL 2020 | O&P ALMANAC
Minnesota
In Minnesota, Senate counsel and MN Medicaid/DHS are working on a bill to broaden the scope of prescribers of O&P to Medicaid recipients to match Medicare standards. Specifically, the bill will seek to include physician assistants, nurse practitioners, and clinical nurse specialists.
Ohio
The Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board is seeking comments and feedback on rules implementing recently enacted changes to Ohio law that allow the Occupational Therapy, Physical Therapy, and Athletic Trainers Board to grant the authority to an individual who is not licensed to practice prosthetics to engage in the 3D printing of open-source prosthetic kits. Visit the Ohio page on the AOPA Co-OP for details.
Submit Your State News
To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org. For up-to-date information about what’s happening in O&P in your state, visit the AOPA website.
