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Jurisdiction B & C Orthotics & Prosthetics (O&P) POE Advisory Group Meeting Minutes – May 22, 2025

Meeting Date and Time: May 22, 2025, 11:00 am ET

Facilitator: Judie Roan, JC POE Sr. Analyst

Advisory Group Members: Kimberly Hanson, Aaron Sorensen, James Del Bianco, Curt Betram, Rachel Hatty, and Danielle Sparks

Agenda:

  1. Welcome & Introductions
  2. News & Updates
  3. POE Educational Activities
  4. Feedback & Suggestions/Open Discussion
  5. Online Tools and Spotlight
  6. Meeting Adjourned
  1. Welcome & Introductions

    Judie welcomed the group to the meeting and reviewed the primary role of the POE AG. Judie also reminded members to complete the survey every quarter.

  2. News & Updates

    Judie reviewed recent changes and asked for comments on these articles:

    • Submitting Claims When Billed Amount Exceeds $99,999.99
    • Information about Orthotist and Prosthetist Documentation
      • Members talked about practitioner documentation versus prosthetist documentation for a Lower Limb Prosthesis (LLP).
    • Additional Code Verification
      • Members asked when to bill the L1951 versus the L1952.
      • The L1951 is a custom fit item and L1952 is off-the-shelf. Judie referred members to the PDAC Product Clarification List.External Website
    • CGS Connect®
      • Judie provided the current list of HCPCS codes for CGS Connect®. A member asked if the list ever changes. Judie said codes on CGS Connect® are reviewed and revised regularly. For the list of HCPCS and information on how the program works, see:
  3. POE Educational Activities
    • Judie reviewed the current schedule of webinars available on our Calendar of Events page.
    • A member asked if the LLP webinar includes the requirements for the K2 coverage for microprocessor knees. Judie stated this information is included in the webinar and she will add additional information and remind attendees to review the LCD and PA when providing these items.
    • A member said they are getting denials of MPKs for functional level K2. Judie asked if they contacted customer service, and they said they had not. They will send examples. Judie reviewed the examples and confirmed the issue was resolved.
  4. 4. Feedback & Suggestions/Open Discussion

    The group discussed the following educational events:

    • Webinars
    • Workshops
      • Members asked when CGS plans on hosting in-person workshops again as they find these events beneficial. Judie responded that the Medicare Administrative Contractors (MACs) are currently unable to travel. When that changes, CGS will market any upcoming workshops. CGS is currently considering a workshop in Nashville, TN. Suppliers can watch our electronic mailing list for any updates.
    • Online education
    • Association meetings
  5. Online Tools & Spotlight
    • Judie asked for feedback about online tools. She reviewed the Advanced Modifier Engine (AME). Members did not provide any feedback.
    • Judie asked for feedback about other tools. A member said their employees use the myCGS Web Portal all the time and have positive comments.
    • A member asked about resetting their myCGS Password in the portal rather than calling. If users forget their password, they can use the reset password option in myCGS. However, once an account is locked, users must call our Provider Contact Center (PCC) to have their account unlocked. Judie will research if contacting the PCC to unlock a password is a CMS requirement. CGS suggests setting a calendar reminder to log in every 3 weeks to avoid an account lock.

    Judie asked for suggestions for any other feedback or topics.

    The group discussed ABNs.

    • A member asked about blanket ABNs. Judie said that blanket or generic ABNs are not acceptable. The ABN must be specific to that beneficiary and their individual situation unless suppliers give a voluntary ABN for non-covered items.
    • A member asked if an ABN is acceptable for same and similar items. Judie said yes, it is acceptable and referred to Supplier Manual, Chapter 3, Section 13 – Same/Similar Equipment and Advance Beneficiary Notices of Non-Coverage.
    • A member asked if CGS can change editing for same and similar orthoses claim denials. Judie said that CGS has discussed this request and it's not an option at this time. Judie also said many same/similar resources are available on our website, including an article and documentation checklist. She will reissue this information.

    Lastly, Judie reminded the group of the importance of completing the survey.

  6. Meeting Adjourned
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