Based on a benefit category determination from the Centers for Medicare & Medicaid Services (CMS), the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) are revising the knee orthosis (KO) and AFO/(KAFO policy articles. The revision includes information about the proper coding of concentric adjustable torsion-style mechanisms incorporated into orthoses.
According to the advisory article, the distinction in coding relates to the indicated use of the joint and the beneficiary’s medical condition(s). Concentric adjustable torsion-style joints used solely to provide an assistive function for joint motion must be coded L-2999 or L-3999. When concentric adjustable torsion-style joints are used for any condition other than to provide an assistive function for joint motion, they must be coded as durable medical equipment (DME) using the following codes:
- E-1800: Dynamic adjustable elbow extension/flexion device.
- E-1802: Dynamic adjustable forearm pronation/supination device.
- E-1805: Dynamic adjustable wrist extension/flexion device.
- E-1810: Dynamic adjustable knee extension/flexion device.
- E-1815: Dynamic adjustable ankle extension/flexion device.
The effective date of the Local Coverage Determination (LCD) and related policy article revision for the concentric adjustable torsion-style mechanisms will be for claims with dates of service on or after March 13, 2012. The remainder of the LCD and related policy article revisions will be effective for dates of service on or after July 1, 2012.
