A great question was recently raised as to whether a physician can prescribe an AFO (or any device) to a patient they are not physically examining?
That is can telemedicine substitute for the in person examination for a custom made device?
The answer technically turns out to be yes. An eligible prescriber can perform a telemedicine examination and if the documentation supports the need for a Orthotic/Prosthetic, then
yes that telemedicine examination can substitute for an in person exam.
This is according to the LCD and DME MAC Medical Directors. What was not asked was is this for an existing patient, for whom you already have medically necessary documentation or is this for a new patient you have never seen before?
For existing patients, it would be far easier especially since your past history and physical examinations may have the documentation already needed to support medical necessity.
But what if this was a new patient or an existing patient with no pertinent history supporting the need for an AFO? Do you believe that you could obtain the necessary documentation required from a virtual examination?
How could one substantiate muscle power, objective ROM measurements and other testing one may need normally acquired from hands on testing?
All of the illustrations require a hands on technique by the health care provider to obtain these objective data points and providing a proper prescription.
The PHE related Covid relaxation rules do allow for telemedicine examinations for new patients to substantiate medical necessity, but in this area of medicine is it from a practical perspective possible?
Personally, the idea of prescribing a custom fabricated device for a new patient via telemedicine does not sit well with me.
From the perspective of an existing patient, if all that is necessary is to replace an existing patient's AFO, then there is a possibility the virtual exam could work.
Now for the next question, how does one cast or scan the patient for a custom AFO via telemedicine? While that may be possible with an iPhone scanner and a sophisticated patient, how does one fit the patient with a custom fabricated device via telemedicine?
The PHE rules do not extend to fitting and dispensing. Thus, from a practical perspective, while one may theoretically be able to prescribe an AFO as a result of a telemedicine examination,
one cannot fit or dispense the AFO remotely. The Medicare policy writers ask: How can one expect the patient to trim, bend, heat or mold a device to themselves, as many custom fabricated devices may require?
Anyone providing such devices knows that just about every device needs some tweaking from a professional for these sophisticated devices to properly fit.
Lastly, there is no PHE exception to in person fitting as virtual dispensing is not allowed.
To summarize, while virtual prescribing an AFO may be possible, an in-person visit is more than likely for casting/scanning and an in-person examination for dispensing is definitely required.
