What if your Orthotics and Prosthetics (O&P) practice was leaving 10-15 % of potential reimbursements on the table simply due to outdated billing practices? In 2025, CMS has rolled out new policies that have partially reshaped the landscape of orthotic and prosthetic billing. For Orthotics and Prosthetic practitioners and medical practice owners, understanding these shifts is mission-critical. In this post, we’ll walk through the key CMS updates that happened in 2025, spotlight how they may affect your practice, and show why leveraging expert orthotic and prosthetic billing services from CBS Medical Billing & Consulting can give you an edge in the competitive industry.
2025 CMS & DMEPOS Updates:
1. DMEPOS Fee Schedule Adjustments & New Codes
Each January, CMS revises DMEPOS payments. In 2025, the fee schedule reflects a 2.4 % increase after adjustments, including inflation and practice expense factors. (Source: ACC) Additionally, new codes and updated payment policies (especially for lymphedema compression items and prosthetic device labour codes) are being incorporated.
2. Proposed Rule Changes & Regulatory Tweaks
CMS’s proposed a rule (CMS-1828-P) that includes revisions in provider enrollment, accreditation, and payment determinations for DMEPOS suppliers. These changes may influence eligibility, audit triggers, and reimbursement ceilings for orthotic and prosthetic billing.
3. Prior Authorization, Face-to-Face Encounters & Audit Pressure
Certain orthoses require prior authorization, unless delivered under urgent or special conditions. Furthermore, items on the Required Face-to-Face Encounter and Written Order Before Delivery List (currently ~75 items) demand rigorous documentation of clinician encounters before delivery. With these tightening rules, O&P practices face increased risk of RAC audits and compliance scrutiny.
Impacts on Orthotic and Prosthetic Billing (and How to Prepare)
- Compression of reimbursement margins
As fees and allowable amounts shift, practices must recalculate whether certain devices remain profitable under updated pricing. - Higher documentation burden & audit risk
Face-to-face requirements, tighter prior authorization, and stricter order compliance will demand robust record-keeping and policies. - Cash flow stress from delayed payments
Under-billing, denials, or slower reimbursements will strain liquidity—especially for practices carrying device inventory costs upfront. - Denial rates may spike
With more stringent rules, payers will more strongly push back on claims lacking compliance. Errors in modifiers, missing authorizations, or improper coding could be grounds for denial. - Operational complexity
Staff must stay current on evolving codes, compliance rules, audit preparation, appeals, and payer-specific nuances, all of which may distract from patient care.
Best Practices in 2025 for Orthotic & Prosthetic Billing
Proactive Claim Scrubbing & Clean Claims Submission
Avoid rejected claims by pre-checking all field codes, modifiers, patient eligibility, and order completeness. This reduces back-and-forth and accelerates reimbursement.
Rigorous Denial Management & Appeals
Track denials methodically. Refile or appeal promptly with supporting documentation. Use analytics to spot recurring denial trends for proactive corrections.
Documentation & Order Compliance
Ensure face-to-face encounter notes, treating practitioner signatures, detailed plans, and justification are captured consistently, especially for codes subject to extra review.
Monitor Key Metrics (KPIs)
Track metrics such as average claim turnaround, denial rate, days in A/R aging buckets, and clean claim percentage. Use dashboards or dashboards from your billing partner to spot trouble early.
Continuous Training & Audit Readiness
Regularly educate your billing and clinical staff on policy updates, payer rules, and compliance checklists. Perform internal mock audits to stay ahead of external ones.
Why Outsourcing Medical Billing Makes Sense (and How to Do It Right)
Many O&P practices find that in-house billing demands rare expertise, expensive software, and constant regulatory vigilance. Outsourcing via Medical Billing Services offers several advantages:
- Specialized expertise: Outsourcing firms often have depth in L-codes, DMEPOS, and orthotic and prosthetic billing nuances that general billing staff may lack.
- Economies of scale: You pay for services as needed, avoiding full-time overhead.
- Scalability and coverage: Vendors can handle surges, staff turnover, or complex audits without disruption.
- Reduced audit exposure: Expert partners typically embed compliance controls and audit-ready workflows.
However, pitfalls exist: choose a medical billing company that understand O&P, demand transparency, require performance reporting, and align incentives (e.g. shared success models). Avoid vendors that treat your practice as just “another account.”
CBS Medical Billing & Consulting: O&P’s Go-to Partner
When it comes to Orthotics and Prosthetic Billing, CBS Medical Billing & Consulting stands alone as a specialist because:
Core Services & Capabilities
CBS offers Medical Billing Services, full Revenue Cycle Management (RCM), staff training, payer credentialing, audit defense, and compliance consulting. This approach spans from claim scrubbing to denial recovery, A/R resolution and beyond.
Orthotic and Prosthetic Billing Experience
CBS has served providers and practitioners in the O&P space for 15 years. And our founder, Erin Cammarata, has worked in the industry for closer to 30 years. We know L-codes, DMEPOS policy, Medicare nuances, and payer idiosyncrasies. That specialization translates to fewer errors, higher reimbursement, and more confident compliance.
Audit & RAC Management
RAC audits are a persistent threat in the orthotic and prosthetic billing. CBS helps practices proactively minimize audit risk and supports strategies that reduce damage when audits do occur. Our compliance protocols help our clients maintain audit readiness.
Tangible Benefits for Clients
Practices working with CBS often see accelerated cash flow, lower denial percentages, and reduced administrative burden. In many cases, simply redirecting billing to CBS frees clinicians to focus on patient care rather than paperwork.
How to Engage & What to Expect
When you partner with CBS, you receive a dedicated team at your aid, custom integration with your workflow, transparent reporting, and consistent communication.
Start with a free consultation to benchmark your practice’s orthotic and prosthetic billing health. From there, CBS tailors a package, whether partial support or full outsourcing, to match your needs and goals.
Conclusion
The year 2025 has been a sort of turning point for Orthotics and Prosthetic Billing. With CMS tightening rules, increasing audit scrutiny, and updating payment models, practices that don’t adapt to these new factors risk falling behind financially and operationally. The good news? Smart preparation, better workflows, and the right medical billing partner can turn these challenges into opportunities for smoother revenue, fewer denials, and more time for patient care.
If you’re ready to improve your orthotic and prosthetic billing practices, you’re in luck. Reach out to CBS Medical Billing & Consulting today for a free consultation and let experts in Medical Billing Services carry the burden, so you can focus on transforming lives.
