Financial Advantages of Using ProComp in Your O&P Practice 

ProComp: A Win-Win for Patients, Practices, and Technicians

ProComp brings many advantages to the O&P community. This game-changing composite material is made by infusing a homopolymer polypropylene with carbon fiber through a high-temperature and high-pressure lamination process. ProComp is 25% stiffer than standard homopolymer polypropylene, yet it is still easily adjusted with heat. (See our article “Clinical and Fabrication Advantages of ProComp for Orthotics and Prosthetics” for an in-depth look at ProComp.)

For the patient, ProComp equates to greater comfort. For the fabricator, its benefits also include a lower shrinkage rate, greatly reduced gait creep, decreased fabrication time, and a much cleaner finish.

For the O&P practice itself — the business behind the design and fabrication of devices — ProComp brings an additional benefit in the form of increased reimbursement amounts. That means ProComp actually can become an income generator for a practice.

Here we’ll explore how this works through hypothetical reimbursements for using ProComp to fabricate several common orthotic and prosthetic devices.

Orthotics

ProComp has been reviewed by the American Orthotic and Prosthetic Association (AOPA) CRC (Coding and Reimbursement Committee), and in the committee’s opinion, one can use code L2755 as an add-on when a lower extremity orthosis is fabricated from the material. The L2755 descriptor is: “Addition to lower extremity orthosis, high strength, light weight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthoses only.” (See the L2755 – 2019 Fee Schedule.)   

The CRC also offered an opinion on the application of the code according to the descriptor, indicating that the “per segment” allows double use of the code even for a solid ankle AFO. Segment refers to the body segment being controlled by the orthosis. To review these letters of opinion, please contact Curbell O&P.                                                                                                          

With the above rendered opinion, ProComp can become an income generator for a practice when used in the fabrication of a lower extremity custom orthosis.

Consider the following example, in which a practice could receive an added reimbursement of $210.99 for an L1960 – Custom Fabricated Solid Ankle AFO by using ProComp. Here we’ll use reimbursement values from the Healthcare Common Procedure Coding System (HCPCS) for California, and presume three solid ankle AFOs can be made from one 3/16″ X 32″ X 48″ sheet of ProComp.
 

Custom Fabricated Solid Ankle AFO
   $686.13 L1960 – Custom Fabricated Solid Ankkle AFO
  + $253.28 L2755 – Add-On Code (2 x $126.64 per segment)   
  -$42.29 Cost of 1/3 of one 3/16" x 32" x 48" ProComp sheet                   
  = $897.12 Reimbursement for ProComp L1960         
INCOME CALCULATION:
   $897.12 Reimbursement for ProComp L1960
  - $686.13 Reimbursement for non-ProComp L1960
  = $210.99 Additional reimbursement to the practice per ProComp L1960

Prosthetics

When 1/2″ ProComp was introduced to the O&P market in January 2019, it was simultaneously submitted to the AOPA CRC for their opinion of its use in prosthetics. The AOPA CRC rendered the opinion that ProComp could be used for Definitive Socket Add-On Codes L5940 for a Below Knee (BK) socket, L5950 for an Above Knee (AK) socket, and L5960 for a Hip Disarticulation.

Here are three ProComp financial impact examples for prosthetics using HCPCS reimbursement values for California, and blister forming a socket using a 1/2″ X 16″ X 16″ ProComp Sheet:

BELOW KNEE (BK)
  $3014.99 L5301
  + $527.30 L5940
  -$40.04 Cost of 1/2" x 16" x 16" ProComp Sheet
  = $3502.25 Reimbursement for ProComp L5301                             
income calculation
    $3502.25 Reimbursement for ProComp L5301
    + $3014.99 Reimbursement for non-ProComp L5301
    = $487.26 Additional reimbursement to the practice per ProComp L5301

 

Above KNEE (BK)
  $4334.41 L5321
  + $769.51 L5950
  -$40.04 Cost of 1/2" x 16" x 16" ProComp Sheet
  = $5063.88 Reimbursement for ProComp L5321                           
income calculation:
  $5063.88 Reimbursement for ProComp L5321
  - $4334.41 Reimbursement for non-ProComp L5321
  = $729.47 Additional reimbursement to the practice per ProComp L5301                  

 

Hip disarticulation
  $5760.07 L5331
  + $953.51 L5960
  -$40.04 Cost of 1/2" x 16" x 16" ProComp Sheet
  = $6673.54 Reimbursement for ProComp L5331                         
income calculation:
  $6673.54 Reimbursement for ProComp L5331
  - $5706.07 Reimbursement for non-ProComp L5331
  = $967.47 Additional reimbursement to the practice per ProComp L5301                  


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The coding opinion expressed is based upon information submitted for review and the clinical experience of the members of AOPA’s Coding and Reimbursement Committee. Neither AOPA nor its Coding and Reimbursement Committee recommends or endorses products/devices of any manufacturer. Regardless of the source of coding information, the final responsibility for correct coding within all established laws, rules, standards, and practices is the sole responsibility of the facility submitting the claim. AOPA and its Coding and Reimbursement Committee accept no responsibility for, and will not be liable for, any actions relating to this coding information.


ABOUT THE AUTHOR

Jeff Wilson, Business Development Manager for the Curbell O&P team, is a nationally recognized expert on the use of performance plastics for orthotic and prosthetic applications. He brings more than 25 years of plastic materials experience to customers in the O&P device fabrication industry. Jeff’s extensive knowledge of plastics and the way their physical, mechanical, and thermal properties dictate their behavior in various environments helps O&P fabricators develop better, stronger, and more comfortable devices for their patients.