Proposed Payment Changes for Orthotics and Prosthetics

Posted by ASHT Practice Division on 01/23/2017

CMS published a new proposed rule that could severely limit the ability of hand therapists to be paid for custom-fabricated orthoses. Rule CMS-6012-P “Establishment of Special Payment Provisions and Requirements for Qualified Practitioners and Qualified Suppliers of Prosthetics and Custom Fabricated Orthotics,” published in the Federal Register January 12, 2017, removes exemptions to quality standards and orthotic certification for OTs and PTs, and would require licensure in orthosis fabrication by the state or the American Board for Certification in Orthotics and Prosthetics or the Board for Orthotist/Prosthetist Certification or a program “approved by the HHS Secretary.” Suppliers who do not meet the standard will not receive payment for custom-fabricated orthoses, and may face revocation of both their Medicare and DMEPOS eligibility. ASHT, in conjunction with HTCC, APTA’s Hand Academy and AOTA, are drafting comments on the proposed rule and will update members as more information is revealed.

Learn more from CMS

How you can help: Review your state practice acts to determine if orthosis fabrication is included in your scope of practice. Please contact ASHT if your practice act does not specify orthosis fabrication.

ASHT President Gary Solomon discusses Rule CMS-6012-P in a new video on the ASHT Facebook page


(9) designing, fabricating, or applying rehabilitative technology, such as selected orthotic and prosthetic devices, and providing training in the functional use of these devices;

(5) Designing, fabricating, applying, recommending, and instructing in the use of selected orthotic or prosthetic devices and other equipment which assists the individual to adapt to the individual’s potential or actual impairment;