Recently there was a report in a publication received mostly by Orthotic and Prosthetic (O&P) providers (mostly orthotists, prosthetists and pedorthists) that created quite a stir for several podiatrists They thought based on this story, that the sky was falling and that DPM's were no longer going to be able to provide certain DME services in 17 states where licensure requirements are in existence.
Those 17 states include: AR AL AZ FL GA KY IA IL MN MS ND NJ OK PA OH TX WA
However the article which I read in its entirety was a summation of a recently announced Medicare Policy issued by the National Supplier Clearinghouse.
And it is my opinion that having read and studied the full policy and spoken with the NSC, this is not going to have an adverse effect on physicians.
Historically the NSC has referred back to states for claim edits based on the state's licensure requirements where licensure is required for O&P services.
The NSC however has not had the reputation for doing the best job of communicating licensure restrictions to the DME MAC.
Thus despite the restrictions In those 17 states where license is required to provide and be paid for O&P services, many O&P services continued to be performed by unlicensed and untrained individuals. The untrained of course is also true in the other 33 states as well.
In a recent policy update from the NSC, it is stated that as of October 2021, they will be enforcing the licensure requirements in those 17 states, for custom orthotics and prosthetics (custom = custom fit and custom fabricated). The policy also repeatedly states that these services can only be provided by specific provider types (e.g. orthotists, pedorthists, etc.) But it fails to mention podiatrists, who for future reference are physicians under Medicare.
In the latter sections of the policy, it specifically delineates the provider types, but again fails to mention physicians (as a type) or number.
However, in Paragraph B of the policy, it clearly states that custom orthotics and prosthetics may be reimbursed by physicians.
So what does all this mean and does it adversely affect DPM's?
What it means is that in the 17 states where there are licensure requirements for providing DME, including custom O&P, one must have a license to perform such services and furthermore the NSC and MACs will enforce a long existing policy, which to date has not been enforced.
Under Medicare, DPM's are physicians and based on our scope of practice, we can provide DME (including custom O&P services) to our patients. Why is this so? Because our state scope of practice says DPMs can provide diagnostic and treatment services to the foot and in many states the ankle and lower leg.
The enforcement of this long existing rule is actually a favorable measure because it takes away the financial incentive of reimbursement away from untrained, unlicensed individuals.
IMO, it is high time that the NSC took this position. My question is why is it that 33 states do not require licensure for the provision of O&P or any DME service?
The bottom line is that, while the O&P story largely regurgitated the Medicare Policy, their headline clearly was aimed at gathering the interest of their audience (non physicians who are licensed to treat O&P.
So the sky is not falling on DPM's, MD's or DO's. At least not on this frontier!