There are some exceptions for Non-contract suppliers that are listed below. Suppliers should refer to the fact sheets available on the CMS website for more information.

• Physicians and Other Treating Practitioners. Refer to Physicians and Other Treating Practitioners, Physical Therapists, and Occupational Therapists fact sheet on the CMS website.
• Hospitals. Refer to Hospitals That Are Not Contract Suppliers fact sheet on the CMS website.
• Medicare Secondary Payer. A non-contract supplier may receive a Medicare secondary payment for a competitively bid OTS back or knee brace furnished to a beneficiary residing in a CBA if the beneficiary is required to use that supplier under his or her primary insurance policy.
• Repairs and Replacements: Medicare allows for the repair of beneficiary owned items by any Medicare-enrolled supplier. Beneficiary owned competitively bid OTS back or knee braces that are replaced, rather than repaired, must be furnished by contract suppliers when beneficiaries obtain these items in a CBA. Refer to Repairs and Replacements of Off-the-Shelf Back and Knee Braces fact sheet on the CMS website.

Modifiers that are appended to claims should follow the Local Coverage Determination (LCD).

For Physicians/Practitioners and Physical and Occupational Therapists the additional modifiers below should also be appended in the following situations:

• When providing brace as part of professional service in beneficiary’s CBA (must be same date of service)
• Beneficiary travels to non-CBA for procedure (surgery) and then goes home (KT not applicable)
• Beneficiary temporarily living in another CBA or non-CBA (KT not applicable)

Physicians/Practitioners - KV
Physical Therapists and Occupational Therapists - J5