Oct 13, 2026
As the mid-term elections near, Congress left Washington DC to campaign but CMS has not stopped its efforts to press forward with O&P policies that impact access to care. However, the federal elections turn out, 2027 is expected to create new political dynamics that NAAOP and the broader O&P profession will have to negotiate.
George Breece Recognized:
First off, NAAOP joins dozens of O&P leaders who have congratulated George W. Breece, NAAOP’s Founding Executive Director, for receiving a Special Lifetime Advocacy Award from the American Orthotic & Prosthetic Association at the National Assembly meeting in Las Vegas in early September. This recognition could not be more well-deserved and NAAOP greatly appreciates AOPA for recognizing George’s lifelong service to individuals with limb loss and limb impairment, and the professionals who serve them.
Upper Limb Coding Developments:
NAAOP, led by the Academy’s Upper Limb Prosthetic Society and the O&P Alliance, continues to be frustrated with the comprehensive effort to improve the upper limb prosthetic coding system run by CMS through the HCPCS Work Group. What began as an ambitious effort to update the code set to better reflect current prosthetic technology and practice has resulted, thus far, in a series of poorly-advised CMS decisions. The Work Group merged technologies into single codes and determined reimbursement levels that prohibit patient access to contemporary partial hand and finger prostheses. A preliminary hearing on some of these new decisions will occur in early November and a strong response from the field is being planned.
Temporary Prior Authorization:
CMS is implementing a one-year prior authorization requirement for certain O&P billing codes for any new Medicare supplier and those who have experienced a change of ownership. These changes were implemented in response to persistent reports of fraud and abuse in the O&P benefit, primarily in the area of off-the-shelf orthotics. CMS is also pursuing another round of OTS orthotic competitive bidding to also fight fraud and reduce orthotic expenditures. NAAOP and the O&P Alliance have been working on policies to lessen the worst aspects of this program which we fear will limit quality, choice, and access to care.
OTS Orthotic Competitive Bidding: Taking the Care out of Healthcare:
NAAOP’s Congressional Fly-In this past summer included an effort to attract key legislators to sign a letter to Dr. Oz, CMS Administrator, asking CMS to implement key provisions of the Medicare O&P Patient Centered Care Act (H.R. 4475 and S. 2329) on existing agency authority, rather than waiting for Congress to pass a federal law. The letter attracted the support of bipartisan House leaders on this bill and was transmitted to CMS in September. A complimentary letter from the O&P Alliance was also sent, raising the issue from multiple fronts. The letter focused on imposing a ban on drop shipment to patient’s homes of custom O&P care and exempting certified and licensed O&P practitioners from the competitive bidding program. This exemption would allow O&P clinicians to continue to serve their patients at the point of service without a competitive bidding contract, but at the competitive bidding rate.