Proposed Medicare Lower Limb Prosthetic Policy-What Does It Mean For The Future of O&P?

CMSOn August 16th, the four DME MACs published a proposed Local Coverage Determination (LCD) and Policy Article that will govern the future provision of lower limb prosthetic service to Medicare beneficiaries.  To say that the proposed policy, in its current form is a “game changer” is an understatement.  The proposed policy represents the first major change to lower limb prosthetic policy in over 20 years and is almost a complete revision of the existing lower limb prosthetic policy.

AOPA has significant concerns regarding the potential impact this policy will have on AOPA members and, more importantly, Medicare beneficiaries who rely on Medicare to cover their artificial limbs.  A multi-level strategy for creating a professional, clinically based response to this proposed policy is being developed and will be communicated to AOPA members in the near future.  This strategy will include coordinated efforts among all industry groups to ensure that we are communicating with “one voice”, representing the entire O&P industry, not just the individual businesses or professionals each group separately represents.  The strategy will also include the education and mobilization of Medicare beneficiaries, who must be their own advocate in ensuring the continued access to high quality, medically appropriate prosthetic care.

As an initial step, AOPA has prepared an executive summary of its major concerns regarding the proposed policy along with a more comprehensive detailed analysis of the potential impact of the proposed policy along with opinion on how the policy can be improved to ensure continued access to medically necessary prosthetic care for Medicare beneficiaries as well as provision of that care at reasonable rates for providers.  Both the executive summary and the comprehensive analysis may be viewed on AOPA’s website at:

AOPA will continue to post information and resources regarding how you can provide your own input regarding the proposed policy revision as they are developed.

AOPA’s take on this issue is that the proposed policy revision is one of the most important issues the O&P industry will face.  The proposed policy, if finalized in its current form, will have a profound impact on your ability to provide high quality, medically necessary prosthetic services to your patients.  Failure to take notice and participate in the public comment process would be a disservice to yourself and your colleagues in the O&P profession.

AOPA’s Take.  Where you go….when you need to know!