February 1, 2018

Question:
We recently heard that the government will be focusing audits on off the shelf orthotics. We have tried to find information but have not been successful. Are you able to direct us?

Answer:
Yes, and thanks for reaching out.   The OIG Work Plan (updated January 2018) includes off the shelf orthotics, focusing specifically on three items.  Several Medicare Intermediaries conducted reviews during 2017.  The carriers findings may have contributed to the OIG adding off the shelf orthotics to the Work Plan.  A key finding was lack of documentation of medical necessity in the patient’s record.  The OIG will review billing trends for 2014-2016 and will be focusing on claims without an encounter in the 12 months prior to the orthotic claim.

• L1833 (Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf)

• L0650: Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf as an area of focus

• L0648 Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Now is a good time to review internal documents related to all DME products.   You will also want to read Sarah Wiskerchen’s article in the November 2017 AAOS NOW “Dispensing DME in Orthopaedics for Medicare” if you have not already done so.

*This response is based on the best information available as of 02/01/18.