The Centers for Medicare & Medicaid Services (CMS) released its final determinations from the First Biannual 2024 Healthcare Common Procedure Coding System (HCPCS) Public Meeting that was held to address the latest code applications it had received. Palmetto GBA submitted a request to the coding committee to create parallel OTS codes for L-1652 and L-1820. The committee approved the request and created codes L-1653 and L-1821. The meeting also resulted in wording changes in two codes.
The changes will be in effect for claims with dates of service on or after October 1.
The new codes are:
- L-1653
Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf
- L-1821
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf
- L-1006
Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla to trochanter, includes all accessory pads, straps and interface, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
The description changes, with changes in italics, are:
- L-1652
Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L-1820
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
To read a summary of the O&P code application and the CMS decision, visit page 43-45 of “HCPCS Level II Final Coding, Benefit Category and Payment Determination” on the CMS website.
