Additional States Requiring Licensure for Prosthetics and Custom-Fabricated Orthotics

In accordance to Change Request 8390, claims edits will be added for prosthetics and certain custom fabricated orthotics in Arkansas, Georgia, Kentucky, Mississippi, and Tennessee effective October 5, 2013. Providers in the aforementioned states must be properly licensed/certified to bill claims for orthotics and prosthetics. Previously CR 3959, released in 2005, implemented an edit for nine states including: Alabama, Florida, Illinois, New Jersey, Ohio, Oklahoma, Rhode Island, Texas, and Washington which required the use of a licensed/certified orthotist or prosthetist to furnish orthotics and prosthetics. For more information, review MLN Matters Article MM8390 (PDF, 92 KB).

Last Updated: 08/05/2016