AdministratorWhat is procedure code L1902?
L1902 (ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF) describes a prefabricated Ankle Orthosis designed to provide compression and resist motion of the ankle foot complex.
Does L1902 need a modifier?
Response: L1902 is covered if your medical necessity documentation conforms with that listed in the LCD. From a coding perspective, you must use the “KX” modifier (use of this stipulates you have the met documentation requirement in the LCD), and either an “RT” or “LT” modifier.
What conditions are AFOs used for?
An ankle foot orthosis (AFO) is used to improve walking patterns by reducing, preventing or limiting movement of the lower leg and foot and by supporting weak muscles. They are also used to maintain joint alignment, accommodate deformity and to help reduce spasticity.
Does Medicare cover ankle/foot orthotics?
Orthotics are devices used to treat injured muscles and joints. Medicare will typically cover 80 percent of the costs for orthotic devices under Medicare Part B if they are deemed medically necessary by a doctor.
Does Medicare cover night splints?
Medicare now differentiates between off-the-shelf and custom fitted type prefabricated AFOs including pneumatic and non-pneumatic walkers and plantar fascia night splints. Traditionally used codes reflect the custom fitted version and the allowable amounts for both are currently the same.
How do you code DME?
Durable Medical Equipment HCPCS Code range E0100-E8002.
Is an AFO considered DME?
Ankle-foot orthoses (AFO) are considered medically necessary DME for ambulatory members with weakness or deformity of the foot and ankle, which require stabilization for medical reasons, and have the potential to benefit functionally.
What is HCPCS code l1902?
L1902 HCPCS Code Description. The codes are divided into two levels, or groups, as described Below: Level I Codes and descriptors copyrighted by the American Medical Association’s current procedural terminology, fourth edition (CPT-4). These are 5 position numeric codes representing physician and nonphysician services.
What does l1951 stand for?
L1951 (ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), plastic or other material, prefabricated, includes fitting and adjustment) describes a prefabricated Ankle Foot Orthosis designed to control dorsiflexion and plantarflexion motions of the ankle foot complex.
What changes have been made to the DME LCDs?
Effective July 1, 2016 oversight for DME MAC LCDs is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the LCDs. Some older versions have been archived.
What are the pre-treatment requirements for l4396 and l4397?
If an L4396 or L4397 is used for the treatment of a plantar flexion contracture, the pre-treatment passive range of motion must be measured with a goniometer and documented in the medical record. There must be documentation of an appropriate stretching program carried out by professional staff (in a nursing facility) or caregiver (at home).