The Centers for Medicare & Medicaid Services (CMS) released the final determinations from its Second Biannual 2024 Healthcare Common Procedure Coding System (HCPCS) code application meetings. The final determinations resulted in new O&P L-codes and A-codes, which will be active and valid for claims with dates of service on or after April 1.
One code was deleted as of April 1: L-8010, “Breast prosthesis, mastectomy sleeve,” because Medicare pays for lymphedema compression treatment items under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies benefit. The new codes and descriptor changes are as follows:
New Codes
- L-0720
Cervical-thoracic-lumbar-sacral-orthoses (CTLSO), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise” to describe VRTX. CMS agreed with the applicant to remove the language “adult size” from the code language.
- L-1933
Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf (to describe the WalkOn Reaction)
- L-1952
Ankle foot orthosis, spiral (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf (to describe WalkOn).
- L-5827
Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping (to be used in conjunction with existing HCPCS Level II codes L-5859 and L5856 to describe the Power Knee)
- L-6028
Partial hand including fingers, flexible or non-flexible interface, endoskeletal system, molded to patient model, for use without external power, not including inserts described by L-6692
- L-6029
Upper extremity addition, test socket/interface, partial hand including fingers
- L-6030
Upper extremity addition, external frame, partial hand including fingers
- L-6031
Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power
- L-6032
Addition to upper-extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal)
- L-6033
Addition to upper-extremity prosthesis, partial hand including fingers, acrylic material
- L-6037
Immediate post-surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, partial hand including fingers
- L-6700
Upper-extremity addition, external powered feature, myoelectronic control module, additional EMG inputs, pattern-recognition decoding intent movement” to describe Intent Decoding Modules (IDMs) for upper limb myoelectric prostheses
- L-7406
Addition to upper-extremity, user adjustable, mechanical, residual limb volume management system (to describe RevoFit)
- A-6515
Gradient compression wrap with adjustable straps, full leg, each, custom (to describe custom full leg gradient compression wraps)
- A-6516
Gradient compression wrap with adjustable straps, foot, each, custom (to describe custom foot gradient compression wraps)
- A-6517
Gradient compression wrap with adjustable straps, below knee, each, custom (to describe custom below knee gradient compression wraps)
- A-6518
Gradient compression wrap with adjustable straps, arm, each, custom (to describe custom arm gradient compression wraps)
- A-6519
Gradient compression garment, not otherwise specified, for nighttime use, each
- A-6611
Gradient compression wrap with adjustable straps, above knee, each, custom, (to describe custom above knee gradient compression wraps)
Descriptor Changes
- L-1951
“Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment” to instead read “Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, 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” to instead read as “Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.”
- L-1971
“Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment” to instead read “Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment.”
- L-6692
“Upper-extremity addition, silicone gel insert or equal, each” to instead read, “Upper-extremity addition, silicone gel insert or equal, with or without locking mechanism, each”
- L-6698
“Addition to upper-extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert” to instead read “Addition to upper-extremity prosthesis, lock mechanism, excludes socket insert”
- A-6549
“Gradient compression garment, not otherwise specified” to instead read “Gradient compression garment, not otherwise specified, for daytime use, each” to describe a daytime gradient compression garment.
- A-6583
“Gradient compression wrap with adjustable straps, below knee, 30-50 mmhg, each” to instead read “Gradient compression wrap with adjustable straps, below knee, each” to describe below knee gradient compression wraps.
- A-6585
“Gradient pressure wrap with adjustable straps, above knee, each” to instead read “Gradient compression wrap with adjustable straps, above knee, each” to describe above knee gradient compression wraps.
- A-6586
“Gradient pressure wrap with adjustable straps, full leg, each” to instead read “Gradient compression wrap with adjustable straps, full leg, each” to describe full leg gradient compression wraps.
- A-6587
“Gradient pressure wrap with adjustable straps, foot, each” to instead read “Gradient compression wrap with adjustable straps, foot, each” to describe foot gradient compression wraps.
- A-6588
“Gradient pressure wrap with adjustable straps, arm, each” to instead read “Gradient compression wrap with adjustable straps, arm, each” to describe arm gradient compression wraps.
To read the document, including the reasons for the revisions, visit “Centers for Medicare & Medicaid Services’ (CMS’) Healthcare Common Procedure Coding System (HCPCS) Level II Final Coding, Benefit Category and Payment Determinations Second Biannual (B2), 2024 HCPCS Coding Cycle,” on the CMS website.
