ABC has received inquiries regarding which Healthcare Common Procedure Coding System (HCPCS) codes are included in its off-the-shelf orthotics accreditation program. To date, no official list of codes that are defined as off-the-shelf orthoses has been published, making it unclear to many facilities what items they can provide. In response, ABC has defined what items and services are specifically allowed through its off-the-shelf orthotics program.
The term off-the-shelf has long been unclear, and some facilities have mistakenly included all prefabricated items into this category. However, according to Federal statute, off-the-shelf orthoses are items that require minimal self adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling or customizing to fit the patient. Simply because an item is prefabricated, does not mean that it doesn’t require customizing in order to achieve the appropriate fit and function, therefore negating the term off-the-shelf. By defining these items, ABC hopes to provide better assistance to its accredited facilities with specific questions about the items they can provide and to ensure that employees are not providing items and services that require a specific certified individual.
Facilities who apply only for the off-the-shelf accreditation program are not required to have any orthotic or prosthetic credentialed individuals on staff. However, if a facility is providing items beyond what is included in ABC’s off-the-shelf code list, they may have to apply for a different accreditation program and will need to employ a certified individual, such as an orthotic fitter, who can provide these services within their scope of practice.
L0120, L0621, L0625, L0628
L3650, L3660, L3652, L3670, L3675, L3710, L3762, L3908, L3912, L3925, L3927, L3932
L1830, L1836, L1902, L1906
L3040, L3050, L3060, L3100, L3170, L3260, L3485, L4350, L4370, L4398
*All “elastic” orthoses that have been cross walked by CMS to code A4466 would also be considered off-the-shelf type devices.This list of codes is subject to change as CMS makes additions and deletions to the DMEPOS code set.
For additional information regarding ABC’s HCPCS code list for off-the-shelf accreditation, please contact Kimberly Meyer at (703) 836-7114 ext. 200 or email@example.com.