CMS looks to demote certified orthotic fitters

WASHINGTON - Stakeholders have sounded off on a CMS proposal that would prohibit certified orthotic fitters (COFs) from providing custom orthotics to Medicare beneficiaries.

The proposal states that custom-fitted, prefabricated orthotics may only be dispensed and billed by “individuals with specialized training”—orthotists, physical and occupational therapists, advanced-practice nurses and physicians.

“(COFs) will lose their livelihood and Medicare beneficiaries who receive their services will face serious challenges accessing care,” said Claudia Zacharias, president and CEO of the Board of Certification/Accreditation, International (BOC).

The proposal was included, along with proposals to expand competitive bidding nationwide and implement bundled payments, in a proposed rule published in the July 11 Federal Register. Comments on the rule were due Sept. 2.

COFs would still be allowed to provide off-the-shelf orthotics, which by design don't require fitting. That makes no sense, say stakeholders.

“Welcome to your new career,” said Tom Fise, executive director of the American Orthotics and Prosthetics Association (AOPA).“CMS allows you to provide a service that is not needed.”

AOPA believes that COFs should be allowed to provide custom orthotics as long as they are under the supervision of a qualified individual, such as a licensed orthotist, says Fise.

“We like that only these persons with expertise can provide custom orthotics,” he said.

However, that's not the norm in many cases, stakeholders say.

“I am sure that many retail places or DME providers don't have skills to that level,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “When you start adding these types of requirements, people stop offering those types of services.”