This webinar presented by Curt Bertram, CPO and Michelle Wullstein with O&P Insight will provide participants with a clear understanding of the definitions, criteria, and documentation requirements necessary for correct coding and claim submission of prefabricated orthoses, distinguishing between off-the-shelf (OTS) and custom fit. This includes the new Healthcare Common Procedure Coding System (HCPCS) codes that take effect on April 1, 2025. By the end of the session, attendees will be equipped with the knowledge needed to accurately classify, document, and bill for orthotic devices under CMS regulations, maintaining high standards of compliance and coding requirements.
By the end of this course, participants will be able to:
Define and Differentiate – Explain the key differences between custom-fitted orthoses and OTS orthoses.
Apply CMS Guidelines – Apply DME MAC documentation and coding requirements to ensure compliance when providing and billing for these orthoses.
Enhance Documentation Accuracy – Recognize essential documentation elements needed to support medical necessity and proper coding of custom-fitted and OTS orthoses to minimize audit risk.
Navigate Reimbursement Policies – Interpret CMS reimbursement rules and coverage determinations related to orthotic coding, ensuring proper claims submission and payment.
Presenters
Curt Bertram, CPO, FAAOP
Chief Clinical Officer at O&P Insight
Curt Bertram has been in the profession since 1990 and is an American Board for Certification (ABC) Certified Prosthetist and Orthotist (CPO), Fellow of the American Academy of Orthotist and Prosthetists (AAOP), and recipient of the American Orthotic and Prosthetic Association (AOPA) and University of Hartford Certificate in O&P Business Management. He is a past President of ABC and is currently Chair for the AOPA Coding and Reimbursement Committee. Curt's experience has afforded him the opportunity to work with domestic and international suppliers on various projects, providing services like market analysis and strategy recommendations, coding and reimbursement support, PDAC application filing, and custom curriculum and training. Curt also works closely with clinicians on defensible documentation to support medical necessity and policy coverage. He also works with businesses to write appeals to assist in reversing denials and recoupment of claw backs. Curt is passionate about protecting revenue, so that businesses can thrive, and they can continue to provide access to care for their patients.
Michelle Wullstein, CPCO
Manager of Compliance and Education at O&P Insight
Michelle has been in the Medicare profession for 18 years and spent most of her career within Noridian Healthcare Solutions, the DME MAC for jurisdictions A and D. She began on the Part B Physician Services side with compliance, billing, customer service, and quality assurance and then transitioned into System Security. In 2011, she made the move to the DMEPOS Outreach and Education division, where she became specialized in orthotics and prosthetics. Michelle joined O&P Insight in 2018 as Lesleigh’s first team member and provides O&P specific medical policy, billing, documentation, and HIPAA compliance support to internal teams and clients. Michelle recently received her AAPC Certification as a Certified Professional Compliance Officer and is eager to help clients strengthen their compliance programs.
Susanne Kasza
Manager of Customer Experience at OPIE Software
Susanne Kasza has over 25 years of experience in the healthcare profession, providing, training, consulting, management, and implementation services, for a wide range of patient care organizations, throughout the United States, Canada, and Australia. She has been with OPIE Software since 2015 and uses her experiences, education, management, and problem-solving skills, to assist every person she works with. Susanne is part of OPIE’s Events and Education team and enjoys working with and celebrating the successes of our partners in the O&P Profession.