Regulatory and Coding Updates

As regulatory and coding updates are announced by CMS and others, we include them below. We also recommend subscribing to several resources that provide in depth analysis and recommendations for these updates. These resources are listed at the bottom of this page along with links to CMS and other websites that are useful to the orthopaedic industry.

August 2014 – CMS has implemented fingerprint-based background checks. Risk categories have been established to determine whether or not a DME provider is subject to this requirement. For more information, please click here.

March 2014 – CMS has published updated definitions to be used for off-the-shelf vs. custom-fitted braces. For more information, click here.

January 2014 – CMS has split 29 codes for prefabricated orthoses into two categories – off-the-shelf and custom-fit. It has also established definitions for off-the-shelf (requires “minimal self-adjustment”) and custom-fit (“requires substantial modification”). For more information, please see the posting at Össur R&R.

DJO Healthcare Services – DME Information and Current News Blog
Össur – O&P Reimbursement and Regulatory News Analysis


CMS National Supplier Clearinghouse
Medicare Claims Processing Manual
Medicare Provider-Supplier Enrollment
A Roadmap for New Physicians (CMS Publications)