Final CMS rule does not define ‘minimal self-adjustment’ for off-the-shelf orthoses

CMS has released a final rule which announced a deferment on action regarding its regulatory definition of “off-the-shelf” orthoses.

The rule, titled “Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies,” goes into effect Jan. 1, 2015 and includes Medicare’s final methodology on fee schedules for DMEPOS items under competitive bidding programs (CBPs). It also states in regard to the definition of off-the shelf (OTS) orthoses, “This rule will not finalize changes to the ‘minimal self-adjustment’ definition to specify certain ‘individuals with specialized training’ with regard to the definition of OTS orthotics under the CBP.” No additional information is provided. CMS did not indicate in the rule when the definition of “minimal self-adjustment” will be finalized.

Recently a letter from Senators Chuck Grassley and Tom Harkin challenged CMS for exceeding the language of the Medicare Modernization Act statute’s definition of “minimal self-adjustment” in its definition of OTS orthoses. The letter was supported by the American Orthotic & Prosthetic Association (AOPA).

“That is very good news, and certainly justifies the energies and resources AOPA, its members and patients invested, as well as what the O&P Alliance and others in the profession have expended in opposing deficient parts of this CMS rule making,” AOAP officials stated in an announcement on the rule.

To read the final rule, visit


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