Additional States Requiring Licensure/Certification for Prosthetics and Certain Orthotics

In accordance to Change Request 8730, claims edits will be added for prosthetics and certain custom fabricated orthotics in North Dakota, Iowa and Pennsylvania on June 17, 2014. Providers in the aforementioned states must be properly licensed/certified to bill claims for orthotics and prosthetics. DMEPOS suppliers should make certain that O/P specialties are appropriately reported to the National Supplier Clearinghouse. Previously CR 3959 released in 2005 and CR 8390 released in 2013 implemented an edit for 14 states including: Alabama, Florida, Illinois, New Jersey, Ohio, Oklahoma, Rhode Island, Texas, Washington, Arkansas, Georgia, Kentucky, Mississippi, and Tennessee which required the use of a licensed/certified orthotist or prosthetist to furnish orthotics and prosthetics. For more information, review MLN Matters Article MM8730 (PDF, 71 KB).

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Palmetto GBA, AG-495

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