The Centers for Medicare & Medicaid Services (CMS) announced the addition of ten orthoses codes that will require a face-to-face encounter and written order prior to delivery (WOPD) as a condition of payment, effective for dates of service on or after April 17. The items are in addition to the six orthosis codes that are already on the list. The new codes are:
- L-0631
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L-0637
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L-1843
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
- L-1932
AFO, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment
- L-1940
Ankle-foot orthosis, plastic, or other material, custom-fabricated
- L-1951
Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment
- L-1960
Ankle-foot orthosis, posterior solid ankle, plastic, custom-fabricated
- L-1970
Ankle-foot orthosis, plastic, with ankle joint, custom-fabricated
- L-2005
Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated
- L-2036
Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated
Refer to the Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426) for more details.
