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SADMERC to Rescind Policy on Prefabricated Orthoses Add On Code

NAAOP is pleased to report that its efforts, and the efforts of other O&P organizations, to challenge the SADMERCÂ’s recent coding decision regarding add on codes have been successful. NAAOP has verbally confirmed that the SADMERC will rescind its policy prohibiting the use of add on orthotic codes in conjunction with prefabricated orthotic base codes. This represents a clear victory for NAAOP and the O&P community in maintaining quality orthotic care.

Officials with the SADMERC stated during a recent conference call that “A formal article rescinding the advisory is forthcoming and a clarification letter will be issued in the next publication cycle.” Pursuant to this statement, the advisory was removed from the SADMERC website and the SADMERC will continue to work on this issue and make recommendations to add on codes where appropriate.

On December 23, 2003, NAAOP wrote to the SADMERC and DMERC Medical Directors, stating that the new “coding clarification” policy would adversely impact practitioners and the Medicare program, and would deprive patients of necessary options that enhance the comfort, stability, and, most-importantly, function of orthoses.

Not only does the action by the SADMERC to rescind the advisory elimination the immediate reimbursement impact of the decision, it also eliminates the need to challenge the process in which the coding advisory was issued. The SADMERC originally issues this advisory without following proper notice and comment procedures. Had the coding advisory been allowed to stand, additional policies may have been issued in the future using the same flawed procedure and averting proper notice and comment guidelines.

Please join NAAOP today to ensure that we are able to remain active and vigilant on behalf of the O&P community. Please contact NAAOP at (800) 622-6740 or on the web

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