September/ October 2018 State by State

State by State

A recap from the AOPA State Reps meeting at the 2018 AOPA National Assembly in Vancouver

Multiple State Alert

Blue Cross Blue Shield (BCBS) Illinois, BCBS Montana, BCBS New Mexico, BCBS Oklahoma, BCBS Texas, and Health Care Service Corp. (HCSC) issued a draft policy that would limit access to microprocessor-controlled prosthetic technology. AOPA, as well as many other O&P organizations, including the O&P Alliance, issued comments on the draft policy, which was removed from the BCBS website on Monday, Oct. 1, 2018. AOPA’s comments are available for review on the AOPA Co-OP, and AOPA will continue to monitor this issue.


Several O&P providers in Arizona are exploring the possibility of expanding the scope of practice for orthotists and prosthetists in the state. The expanded scope of practice would include the ability to bill for Current Procedural Terminology (CPT) codes, specifically the four codes designated for prosthetic and orthotic training.

During the summer AOPA Board of Directors meeting, AOPA Executive Director Tom Fise, JD, recommended that AOPA develop a long-term plan to give serious consideration to expanding O&P’s scope of practice to include more patient-care services, billed through CPT codes. Certified orthotists and prosthetists are the only primary care providers who do not bill both CPT and Health-Care Common Procedure Coding System codes, according to Fise.


Members from Arkansas reported concerns about Medicaid work requirements and the entry of new managed-care organizations beginning Jan. 1, 2019. Many of the states with work requirements have exclusions for individuals with disabilities, but Arkansas has not yet released its criteria.


The California Orthotic and Prosthetic Association continues to push for increases to the MediCal fee schedule and is now working with a health economist to build its case.


AOPA members in Massachusetts reported a MassHealth (Massachusetts Medicaid) proposal, 101 CR 334.00: Payment Rates for Prostheses, Prosthetic Devices, and Orthotic Devices, which would cut the fee schedule for some O&P codes by as much as 17 percent. A public hearing was held on Aug. 17, 2018, for which AOPA submitted written testimony. Several O&P organizations also attended the hearing to present testimony in person. As a result of the feedback received during the public hearing, MassHealth has delayed implementation, pending further review.

O&P providers continue to monitor the situation but have concerns that the proposed cuts may still go through due to the lack of detailed descriptions and documentation of time allotments associated with the provision of orthotic and prosthetic care. MassHealth has requested additional information with respect to the amount of time it takes to provide the services associated with the global payment of the L codes with proposed fee schedule cuts.


AOPA members in Minnesota report a successful transition under the new licensure law, which went into effect Jan. 1, 2018. The law was intended primarily for patient protection purposes.

Minnesota planned to hold a vote on moving forward with pursuing the introduction of insurance fairness in the state in 2019 during its state meeting, held in conjunction with the Northern Plains Chapter Meeting, October 4-5.

Editor’s Note: To submit an update for publication, please email For up-to-date information about what’s happening in O&P in your state, visit the AOPA Co-OP and join the conversation in the AOPA Google+ Community.