New Obstacles for Occupational Therapists Furnishing Custom-Fabricated Orthotics and Prosthetics

AOTA Staff

Update March 21, 2017 

Thank you to all who got involved advocating for the role of occupational therapists in fabricating custom orthotics!  The comment period for this proposed rule closed on March 13, and CMS received almost 4,600 comments.  CMS will take time to review the comments and determine whether to finalize the rule or not.  They have 3 years to issue a final rule, otherwise it expires and must be proposed again for another comment period.  So it could be a while before we have a decision from CMS.  If they do finalize the rule, CMS will publish the final rule in the Federal Register and include the effective date, which is typically at least 60 days from the date of publication.

We are very hopeful that CMS will NOT finalize the rule as written.  We had many OT practitioners contact us and submit comments directly themselves, as well as physicians and surgeons.  AOTA submitted comments, as did the ASHT (American Society of Hand Therapists).  AOTA opposed this proposed regulation and advocated for continued exemption from the DMEPOS accreditation requirements.  We have been successful in the past advocating that OTs should not be required to meet additional requirements and hope that the new administration sees this as overly burdensome and unnecessary. AOTA will continue to follow this issue and provide updates to members as information becomes available.


Occupational therapists and physical therapists have long been exempt from quality and accreditation standards for furnishing and fabricating prosthetics and custom orthotics for Medicare beneficiaries. On January 12, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (pdf) would lift that exemption.

The proposed rule would require OTs and PTs to meet Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) supplier quality and accreditation standards when they furnish and fabricate prosthetics or custom orthotics under the Medicare program. The proposal is an outgrowth of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (“BIPA”). Read a CMS fact sheet about the proposed rule.

In the new proposal, occupational therapists who furnish and fabricate custom orthotics must be “licensed by the state [as a qualified provider of prosthetics and custom orthotics], or…certified by the American Board for Certification in Orthotics and Prosthetics…or by the Board for Orthotist/Prosthetist Certification.”

AOTA is closely reviewing the Training Licensure and Certification requirements in the proposal to respond to concerns with occupational therapy training set forth by CMS.. In addition, CMS states that it will make changes to the quality standards, which will be handled only through sub-regulatory guidance, by posting on the CMS DMEPOS supplier enrollment website. AOTA will be monitoring any changes regarding orthotics quality standards. The proposed provisions could also have a harmful impact on facility settings, including skilled nursing facilities (SNFs).

CMS is accepting comments on the proposed rule until March 13, 2017. AOTA’s Regulatory Affairs staff will be commenting on the new proposed regulations and welcomes your feedback at You can also submit comments directly to CMS.