Skip to main content

A proposed new rule from the Centers for Medicare and Medicaid Services (CMS) would include qualified physical therapists (PTs) among the providers who could furnish and bill for custom orthotics and prosthetics; however, the CMS definition of "qualified" may have administrative and financial implications for PTs.

The proposed rule, issued on January 11, aims to tighten up requirements around who CMS will work with when it comes to making and furnishing devices ranging from glass eyes to exoskeletal systems and finger orthotics. In addition to an estimated 900 PTs who could be affected by the proposed rule, the provisions would also have an impact on facilities including skilled nursing facilities (SNFs) and rehabilitation agencies.

For PTs, the most notable parts of the proposed rule have to do with how a provider would become qualified to participate in the system. According to a fact sheet from CMS, while PTs are among the providers who could participate, they would need to be "licensed by the state [as a qualified provider of prosthetics and custom orthotics], or … certified by the American Board for Certification in Orthotics and Prosthetics … or by the Board for Orthotist/Prosthetist Certification." These requirements would need to be met within a year after CMS posts its final rule, or at the time of the provider's reaccreditation cycle, whichever is later.

CMS is accepting comments on the proposed rule until March 13, 2017. APTA regulatory affairs staff is preparing comments to CMS and will post a fact sheet on the proposal in the coming weeks.


You Might Also Like...

Article

APTA Town Hall: Provide Your Input on Draft Code of Ethics for the Profession

Apr 1, 2025

Join one of two virtual town halls in April to add your thoughts to the Board motion being brought to the 2025 House of Delegates.

Article

APTA and Coalition Partners Fight Against Potential Cuts to Medicaid

Mar 26, 2025

On March 24, APTA joined over a dozen other medical organizations in a letter urging Congress to avoid any cuts to Medicaid in the upcoming Budget Reconciliation

News

What to Consider Before Deciding to Participate in MIPS Cost Category

Mar 25, 2025

The participation deadline for the 2024 reporting year is March 31 — before performance feedback is available from CMS.