Section 1833(e) of the Social Security Act precludes payment to any provider of services unless "there has been furnished such information as may be necessary in order to determine the amounts due such provider. It is expected that the beneficiary's medical records will reflect the need for the care provided. Items that are primarily constructed of inelastic material (e.g., canvas, cotton or nylon (not all-inclusive)) that are incapable of providing the necessary immobilization or support to the body part for which it is designed must be coded using A4467 (BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANY TYPE). WebL1951: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment. Acta Orthop Scand. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". Clin Orthop. 03/29/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. Specialized hip braces are considered medically necessary for children with hip disorders to stabilize the hip and/or to correct and maintain hip abduction. TUG and 30CST results were always better in the study group without any clinically important improvement in both groups. This fitting does not require expertise of a certified orthotist or an individual who has specialized training in the provision of orthoses to fit the item to the individual beneficiary. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. L1980 (ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP, CALF BAND/CUFF (SINGLE BAR 'BK' ORTHOSIS), CUSTOM FABRICATED) describes a custom fabricated AFO designed to control inversion and eversion motions of the ankle foot complex. JR Andrews, GL Harrelson, eds. Orthosis is the proper term that applies to a custom-fabricated brace/splint. Lachmans test of assessing the anterior translation of the tibia on the femur with the knee in 20 to 30 degrees of flexion is the most accurate diagnostic examination. Prophylactic knee braces have not been shown to be effective. The elements of a kit may be packaged and complete from a single source or may be an assemblage of separate components from multiple sources by the supplier. "JavaScript" disabled. authorized with an express license from the American Hospital Association. L codes are codes that bill for orthotics and prosthetics provided to patients. bottom: 20px; Gauntlet closure may be straps, hook and loop, laces or equal. Note: When used for this indication, the knee brace is considered a functional (derotational) knee brace and is considered DME. Product information such as manufacturer, part number or part name must be recorded in the medical records. 2021 E/M Guidelines and Consultation Codes, Two Orthopaedic Surgeons, Two Separate Surgeries, Category III Codes Effective July 1, 2022, Fee Setting: Category III Codes or Unlisted Procedures, Teaching Physician Rules Related to E&M Code Selection, Interposition Arthroplasty CMC Joint Denial. O'Connor FG, Mulvaney SW. Patellofemoral pain. The orthosis may or may not include joints or hinges for additional support. J Pediatr Orthop. Decrease in knee joint pain and increase in function in patients with medial compartment arthrosis: A prospective analysis of valgus bracing. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Structure contacts calf, lower leg, and foot to provide control. CMS and the DME MACs provide a list of the specified codes, which is periodically updated. Knee braces composed of high-strength, lightweight material are considered experimental and investigational for other indications. WebP9011 Which code represents an IV tubing extension set? Spinal orthoses: TLSO and LSO. Prefabricated walking boots are coded using codes L4360, L4361, L4386 or L4387. Refer to the long code narrative and any relevant coding guideline for the criteria applicable for each HCPCS code.For items where the HCPCS code does not specify elastic or other similar terminology for stretchable material, the following guidelines apply: Ankle-foot orthoses described by codes L1900, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980,L1990, extend well above the ankle (usually to near the top of the calf) and are fastened around the lower leg above the ankle. Reproduced with permission. Acta Ortop Bras. Local Medical Review Policy. Medicare program. The entire circumference of the plastic shell must be the same rigid material. Language services can be provided by calling the number on your member ID card. For the use of concentric adjustable torsion style mechanisms used for joint contracture, see CPB 405 - Mechanical Stretching Devices for Contracture and Joint Stiffness. For the patient with a second-degreeMCL sprain (partial tear), it is appropriate to prescribe an custom-fitted prefabricated functional knee brace after the rehabilitative knee brace is removed, and have the patient use this brace for up to 8 weeks after injury. The orthosis may or may not include joints or hinges for additional support. are considered experimental and investigational for other indications because their effectiveness for indications other than the ones listed above has not been established. not endorsed by the AHA or any of its affiliates. Assembly of the item and/or installation of add-on components and/or the use of some basic materials in preparation of the item does not change classification from OTS to custom fitted. Am Fam Physician. For example, adjustment of straps and closures, bending or trimming for final fit or comfort (not all-inclusive) fall into this category. is considered experimental and investigational because there is no proven clinical benefit to the inflatable air bladder incorporated into their design. Saunders Co.; 1996:613-645. Flexible spinal orthoses that are made primarily of nonelastic material (e.g., canvas, cotton or nylon) or that have a rigid posterior panel are considered braces. The height of the rigid calf band/cuff terminates well-above the ankle (usually near the top of the calf) and the band/cuff is fastened around the lower leg above the ankle. POLICY SPECIFIC DOCUMENTATION REQUIREMENTS. A prefabricated orthosis may be considered an OTS or a custom fitted device that may be trimmed, bent, molded (with or without heat), or otherwise modified for use by a specific beneficiary. Philadelphia, PA: W.B. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Direct supervision means that a physician was physically present during the application. Additional support is from wraparound straps. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Contains a rocker bottom sole with a custom arch support; and. There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. Orthoses is the plural noun for two or more custom-molded or pre-fabricated supports. In proving that one brace is superior to another, the manufacturer must demonstrate brace efficacy in studies designed to approximate the in vivo situation. Because there are four different MACs for the 50 states, it would be best to check with the MAC for your region if they will reimburse the L 3933 code for the silver ring splints. The CyMedica QB1 Knee Brace is used for the treatment of quadriceps muscle atrophy. Neither the United States Government nor its employees represent that use of It includes any type ankle joint and closure components. Medicare contractors are required to develop and disseminate Articles. The patient must also have the capacity for full extension of the knee, both prior to the initial contact and at the terminal stance (to lock and unlock the knee) . The AMA does not directly or indirectly practice medicine or dispense medical services. The table limits durable orthotics to 1 per limb per year. This AFO is custom fabricated per the DMEPOS quality standards, Appendix C. L1970 (ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM FABRICATED) describes a custom fabricated AFO designed to control inversion, eversion, dorsiflexion, plantarflexion, and horizontal rotation motions of the ankle foot complex. Medicare contractors are required to develop and disseminate Local Coverage Determinations (LCDs). A prefabricated, locking knee joint, positional knee orthosis describes a prefabricated knee orthoses with joint(s) which lock the knee into a particular position. An impression (usually by means of a plaster or fiberglass cast) of the specific body part is made directly on the patient, and this impression is then used to make a positive model of the body part from which the final product is crafted; or. Revision Effective Date: 02/01/2021NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:Revised: Braces Benefit to braces benefit Revised: Coding Guidelines to CODING GUIDELINES Revised: Ankle-Foot Orthosis to ankle-foot orthosis Revised: CAD-CAM to computer-aided design/computer-aided manufacturing (CAD/CAM) GENERAL REQUIREMENTS: Revised: Coding Guidelines to CODING GUIDELINES Revised: off-the-self to OTS MODIFIERS: Revised: KX, GA, and GZ MODIFIERS: to GA, GZ, KX, LT and RT MODIFIERS: Added: Statement regarding use of RT and LT, with reference to CODING GUIDELINES section for additional informationCODING GUIDELINES: Revised: Language describing parallel code set availability for identical types of products Revised: Coding guideline language for HCPCS codes L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, and L2006 Revised: Coding guideline information for HCPCS codes L1910, L1932, and L1951, to include that there are no additional HCPCS codes for these types of orthoses Added: Long HCPCS descriptions to coding guidelines for HCPCS codes L2006, L2340, and L2755Revised: Language describing the coding of foot orthotics as L-codes or A-codes Revised: Durable Medical Equipment to durable medical equipment Revised: Braces to braces Revised: Format of long HCPCS descriptions for HCPCS codes A9270 and L420505/26/2022: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. Jerosch J, Thorwesten L, Bork H, Bischof M. Is prophylactic bracing of the ankle cost effective? each item on two separate claim lines using the RT and LT modifiers and 1 unit of service (UOS) on each claim line. A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted. may be eligible for payment in some circumstances even though they are not durable and do not fit within the definition of DME. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. Used by a beneficiary who is ambulatory; and. Refer to the LCD-related Standard Documentation Requirements article, located at the bottom of this Policy Article under the Related Local Coverage Documents section for additional information regarding GENERAL DOCUMENTATION REQUIREMENTS and the POLICY SPECIFIC DOCUMENTATION REQUIREMENTS discussed below.General RequirementsThe supplier must include on the claim line the diagnosis code(s) for HCPCS codes L4396, L4397, L4392 and L4631.For a custom-fabricated orthosis, there must be documentation in the supplier's records to support the medical necessity of that type device rather than a prefabricated orthosis. The interface material is constructed of canvas, closed cell foam or equal. They are typically used for early rehabilitation following knee surgery. Rigid strut connects foot plate to shin shell. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. For coverage under this benefit, the orthosis must be a rigid or semi-rigid device, which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. Information provided in this policy article relates to determinations other than those based on Social Security Act 1862(a)(1)(A) provisions (i.e. Evaluation of the member, measurement and/or casting, and fitting/adjustments of the orthosis are included in the allowance for the orthosis. The AMA does not directly or indirectly practice medicine or dispense medical services. Saunders Co.; 1991:328-329. All Rights Reserved. These code narratives are correct and must be used for Medicare billing, without regard to how the product is provided to the beneficiary at the final delivery.There are products that may be either fit by the beneficiary or require custom fitting at the time of final delivery. The scope of this license is determined by the AMA, the copyright holder. In collateral ligament injuries that do not involve a complete tear (second degree injuries), the torn fibers are internally splinted from excessive stress by the intact ligament fibers, and the use of the knee immobilizer or rehabilitative brace is only for comfort. Included in the code are closure components. A systematic review of physical interventions for patellofemoral pain syndrome. If the medical record, including the judgment of the attending practitioner, indicates that the condition is of long and indefinite duration, the test of permanence is considered met. There is no clear-cut advantage of shell braces over strap braces. Revision Effective Date: 07/01/2020ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:Added: ICD-10 diagnosis codes E08.610, E09.610, E10.610, and E11.610 to Group 2 Codes for L463106/04/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. All Rights Reserved. Knee-ankle-foot orthoses (KAFO) described by codes L2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2126, L2128, L2132, L2134, L2136, and L4370 are covered for ambulatory beneficiaries for whom an ankle-foot orthosis is covered and for whom additional knee stability is required.If the basic coverage criteria for an AFO or KAFO are not met, the orthosis will be denied as not reasonable and necessary.AFOs and KAFOs that are custom-fabricated are covered for ambulatory beneficiaries when the basic coverage criteria listed above and one of the following criteria are met: If a custom fabricated orthosis is provided but basic coverage criteria above and the additional criteria 1-5 for a custom fabricated orthosis are not met, the custom fabricated orthosis will be denied as not reasonable and necessary.L coded additions to AFOs and KAFOs (L2180, L2182, L2184, L2186, L2188, L2190, L2192, L2200, L2210, L2220, L2230, L2232, L2240, L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, L2340, L2350, L2360, L2370, L2375, L2380, L2385, L2387, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2500, L2510, L2520, L2525, L2526, L2530, L2540, L2550, L2750, L2755, L2760, L2768, L2780, L2785, L2795, L2800, L2810, L2820, L2830) will be denied as not reasonable and necessary if either the base orthosis is not reasonable and necessary or the specific addition is not reasonable and necessary.Concentric adjustable torsion style mechanisms used to assist knee joint extension are coded as L2999 and are covered for beneficiaries who require knee extension assist in the absence of any co-existing joint contracture.Concentric adjustable torsion style mechanisms used to assist ankle joint plantarflexion or dorsiflexion are coded as L2999 and are covered for beneficiaries who require ankle plantar or dorsiflexion assist in the absence of any co-existing joint contracture.Concentric adjustable torsion style mechanisms used for the treatment of contractures, regardless of any co-existing condition(s), are coded as E1810 and/or E1815 and are covered under the Durable Medical Equipment benefit (refer to the CODING GUIDELINES section in the LCD-related Policy Article). The pictorial examples given for each code are provided only for instructional purposes and are not to be construed as the only type of orthosis that can be fabricated using that orthotic code. The pre-tibial shell can be constructed from thermosetting materials, thermoplastics, or composite type materials.Code L2755 (ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRENGTH, LIGHTWEIGHT MATERIAL, ALL HYBRID LAMINATION/PREPREG COMPOSITE, PER SEGMENT, FOR CUSTOM FABRICATED ORTHOSIS ONLY) describes an addition to a lower extremity orthosis composed of high strength and/or lightweight material such as Kevlar, carbon fiber or other laminated or impregnated composite material.A non-ambulatory ankle-foot orthosis may be either an ankle contracture splint, night splint or a foot drop splint.A static or dynamic positioning ankle-foot orthosis (L4396, L4397) is a prefabricated ankle-foot orthosis which has all of the following characteristics: Designed to accommodate either plantar fasciitis or an ankle with a plantar flexion contracture up to 45; and. 2nd Edition. copied without the express written consent of the AHA. Reider explained that [w]e currently favor the new generation of custom-fitted prefabricated braces for economic reasons, saving the more expensive custom-molded types for the harder-to-fit athlete (Reider et al, 1996). The LCD Tracking Sheet is a pop-up modal that is displayed on top of any Proposed LCD that began to appear on the MCD on or after 1/1/2022. Sports Med. This documentation must be available upon request. Custom-fitted and custom-fabricated back braces are considered experimental and investigational when these criteria are not met. These orthoses are designed for a member who can bear weight on the knee and is capable of ambulation. Primary construction is a rigid calf cuff and rigid foot plate section joined by a flexible posterior strut. Anterior flexion (forward bending) or posterior extension (backward bending) in the sagittal plane. The Tracking Sheet provides key details about the Proposed LCD, including a summary of the issue, who requested the new/updated policy, links to key documents, important process-related dates, who to contact with questions about the policy, and the history of previous policy considerations. There are no hinges or joints. This AFO is custom fabricated per the DMEPOS quality standards, Appendix C. L1902 (ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF) describes a prefabricated ankle orthosis (AO) designed to provide compression and resist motion of the ankle foot complex. Medicare does recognize elastic supports that have additional plastic or metal inserts. An addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom-fabricated orthoses describes an addition to a lower extremity orthosis composed of high strength and/or lightweight material such as kevlar, carbon fiber or other laminated or impregnated composite material. The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Rehabilitative (or rehabilitation) braces are used as alternatives to knee immobilizers used immediately after surgery or injury to both control knee motion and protect the knee during rehabilitation. You can use the Contents side panel to help navigate the various sections. ), Computer Aided Design and Manufactured Orthoses. 2002;73(3):277-281. This AFO is custom fabricated per the DMEPOS quality standards, Appendix C. L1930 (ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT) describes a prefabricated AFO designed to control inversion, eversion, dorsiflexion, and plantarflexion motions of the ankle foot complex. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. Coverage of a replacement interface is limited to a maximum of one (1) per 6 months. The nurses are adding splint application codes to the encounter forms, such as 29125 and 29515, but the coder only wants to report the HCPCS supply code. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. list-style-type: lower-roman; Note: Most Aetna traditional plans cover durable medical equipment (DME) as a standard benefit. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. This technology includes specialized probes/digitizers and scanners that create a computerized positive model, and then direct milling equipment to carve a positive model. Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary. Revision Effective Date: 01/01/2020REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Primary construction is a single metal upright (medial or lateral) joined to a rigid calf band, free motion ankle joint, and stirrup component attached to an orthopedic shoe. The beneficiary's medical records include thetreating practitioner'soffice records, hospital records, nursing home records, home health agency records, records from other healthcare professionals and test reports. Despite their relatively high cost, knee braces composed of carbon composites (also known as carbon fiber or graphite) are favored by competitive athletes because of their lightness. Question: Answer: A custom-fabricated orthosis is one, which is individually made for a specific beneficiary starting with basic materials including, but not limited to, plastic, metal, leather, or cloth in the form of sheets, bars, etc. When there is an expectation of a medical necessity denial, suppliers must enter the GA modifier on the claim line if they have obtained a properly executed Advance Beneficiary Notice (ABN) or the GZ modifier if they have not obtained a valid ABN.Claim lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information. A PCL with products which have received a coding verification can be found on the PDAC web site. Fabrication of an orthosis using CAD/CAM or similar technology without the creation of a positive model with minimal self-adjustment at delivery is considered as OTS. No authors listed. Am J Phys Med Rehabil. Reg Vol 217) requires a face-to-face encounter and a Written Order Prior to Delivery (WOPD) for specified HCPCS codes. Taping and bracing. Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. An orthosis (brace) is a rigid or semi-rigid device which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. This AFO can be constructed from thermosetting materials, thermoplastics, or composite type materials. If the expense for repairs exceeds the estimated expense of providing another entire orthosis, no payment will be made for the amount in excess.The allowance for the labor involved in replacing an orthotic component that is coded with a specific L-code is included in the allowance for that component. Some older versions have been archived. CPT is a trademark of the American Medical Association (AMA). A prefabricated elastic knee orthosis with joints describes a prefabricated knee orthoses constructed of latex, neoprene, spandex or other elastic material. Included in the code are closure components. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Recommended strategies include weight loss and knee bracing to unload knee joint forces. These investigators concluded that "[w]e now feel that time and money might be better spent on preventive conditioning than for braces.". The springwire is contoured into a coiled spring below the ankle and above the shoe sole. Current Dental Terminology © 2021 American Dental Association. If a supplier delivers an item prior to receipt of a WOPD, it will be denied as not reasonable and necessary. E-MAG Active, a newer Stance Control Knee Ankle Foot Orthosis (SCKAFO) in the context of workers compensation. If a custom fit code is billed when minimal self-adjustment was provided at the final delivery, or if an OTS code is billed when more than minimal self-adjustments were made at the final delivery, the claims will be denied as incorrect coding. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. not endorsed by the AHA or any of its affiliates. If your session expires, you will lose all items in your basket and any active searches. For example, adjustment of straps and closures, bending or trimming for final fit or comfort (not all-inclusive) fall into this category. My provider wants to bill the application code 29125 for off the shelf splints. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. Instructions for enabling "JavaScript" can be found here. The AFO is designed to provide rigid immobilization of the ankle-foot complex in the sagittal, coronal, and transverse planes. } When claims for code(s) L4002, L4010, L4020, L4030, L4040, L4045, L4050, L4055, L4060, L4070, L4080, L4090, L4100, L4110,L4130, and L4392 are billed at the time of initial issue of a base orthosis, the addition code(s) will be rejected as incorrect coding.Suppliers should contact the Pricing, Data Analysis, and Coding (PDAC) contractor for guidance on the correct coding of these items. A collection of components, materials, and parts that require further assembly before delivery of the final product. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. It may be a shoe-like item, an item that is used inside a shoe and may or may not extend outside the shoe, or an item that is attached to a shoe. Calf cuff height terminates well above the ankle (usually to near the top of the calf) and are fastened around the lower leg above the ankle. L1907 (ANKLE ORTHOSIS, SUPRAMALLEOLAR WITH STRAPS, WITH OR WITHOUT INTERFACE/PADS, CUSTOM FABRICATED) describes a custom fabricated AO designed to control motion of the ankle and mid-foot. Code L4631 includes all additions including straps and closures. Orthotic devices for treating patellofemoral pain syndrome. Clin Sports Med. --> If a concentric adjustable torsion style mechanism in the knee joint is used solely to provide an assistive function for joint extension, it must be coded as L2999 (See Coverage Indications, Limitations, and/or Medical Necessity section of the related LCD).All claims for devices that contain a concentric adjustable torsion style mechanism in the ankle joint for any condition other than an assistive function to joint plantar- or dorsiflexion motion must be coded as durable medical equipment using code E1815 (DYNAMIC ADJUSTABLE ANKLE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL). Buckley SL. This Clinical Policy Bulletin may be updated and therefore is subject to change. Saunders Co.; 1991; Ch. The fabrication may involve using calculations, templates and components. End Users do not act for or on behalf of the CMS. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or Code L4398 is used for an ankle-foot orthosis which is worn when a beneficiary is non-ambulatory.Some replacement items have unique Healthcare Common Procedure Coding System (HCPCS) codes. L1900 (ANKLE FOOT ORTHOSIS, SPRING WIRE, DORSIFLEXION ASSIST CALF BAND, CUSTOM FABRICATED) describes a custom fabricated AFO designed to control inversion, eversion, dorsiflexion, and plantarflexion motions of the ankle foot complex. 7500 Security Boulevard, Baltimore, MD 21244. Examples: Generation II Unloader, Orthotech Performer, Vixie Enterprise MKSIII. 1998;17(3):635-655. Knee rehabilitation. LCD - Ankle-Foot/Knee-Ankle-Foot Orthosis (L33686). "eibkf4". In: Physical Rehabilitation of the Injured Athlete. Use of knee braces in sport. Foot plate must extend to the metatarsal heads and may extend as far as the toe tips. End User License Agreement: By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. A rigid prefabricated positional knee orthosis with adjustable knee joints (unicentric or polycentric) describes prefabricated knee orthoses that have double uprights and adjustable flexion and extension joints. Patient-reported outcomes were assessed with the International Hip Outcome Tool (iHOT-33), and Copenhagen Hip and Groin Outcome Scores (HAGOS). are considered medically necessary for persons who meet criteria for a knee orthosis and whose weight is greater than 250 lbs. Please check benefit plan descriptions for details. If a similar item is subsequently provided by an unrelated supplier who has obtained a WOPD, it will be eligible for coverage. States are listed across the top of the page so you will have to find your location and scroll down. The allowance for the labor involved in replacing an orthotic component that is coded with the miscellaneous code L4210 is separately payable in addition to the allowance for that component.Addition codes L4002, L4010, L4020, L4030, L4040, L4045, L4050, L4055, L4060, L4070, L4080, L4090, L4100, L4110,L4130, and L4392 are for billing of replacement components and are not payable at initial issue of a base orthosis. Dixit S, DiFiori JP, Burton M, Mines B. L 3906 is a custom fabricated static wrist hand orthosis. THE INFORMATION, PRODUCT, OR PROCESSES DISCLOSED HEREIN. Refer to the long code narrative and relevant coding guideline for the criteria applicable for each HCPCS code. A Wheaton Brace is considered experimental and investigational for other indications because its effectiveness for indications other than the one listed above has not been established. color: #FFF; The L code should be submitted with the appropriate modifier signifying right or left (RT or LT). You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. MACs are Medicare contractors that develop LCDs and process Medicare claims. } This process requires the use of basic materials including, but not limited to plastic, metal, leather or cloth in the form of uncut or unshaped sheets, bars or other basic forms and involves substantial work such as vacuum forming, cutting, bending, molding, sewing, drilling and finishing prior to fitting on the patient. An asterisk (*) indicates a required field. The best prefabricated splint for wrist drop is this dynamic extension splint. CPT is a trademark of the American Medical Association (AMA). Functional braces usually involve some form of hyperextension stop, as well as straps or fitted shells to control rotation. A foot drop splint/recumbent positioning device and replacement interface will be denied as not reasonable and necessary in a beneficiary with foot drop who is nonambulatory because there are other more appropriate treatment modalities.AFOs AND KAFOs USED DURING AMBULATION:Ankle-foot orthoses (AFO) described by codes L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2106, L2108, L2112, L2114, L2116, L4350, L4360, L4361, L4386, L4387 and L4631 are covered for ambulatory beneficiaries with weakness or deformity of the foot and ankle, who: Require stabilization for medical reasons, and. U0# L _rels/.rels ( MO0HBKwAH!T~I$'TG~;#wqu*&rFqvGJy(v*K#FD.W =ZMYbBS7 ?9Lsbg|l!USh9ibr:"y_dlD|-NR"42G%Z4y7 PK ! ol.numberedList LI { Replacement components that do not have a unique HCPCS code must be billed with a "not otherwise specified" code - L2999. Code A4467 is denied as noncovered (no Medicare benefit). The AMA does not directly or indirectly practice medicine or dispense medical services. Additional interfaces will be denied as not reasonable and necessary.Medicare does not reimburse for a foot drop splint/recumbent positioning device (L4398) or replacement interface (L4394). The beneficiary could not be fit with a prefabricated AFO; or. Applicable FARS\DFARS Restrictions Apply to Government Use. Functional knee braces are considered not medically necessary when used primarily for sports, because participation in sports is considered an elective activity. Your MCD session is currently set to expire in 5 minutes due to inactivity. *Suggested L Codes: The responsibility for accurate coding lies with the patient care facility that selects the product, fits the patient, and bills for the service. Code L4631 is a custom fabricated ankle-foot orthosis which has all of the following characteristics: Allows for varus or valgus deformity correction; and. Knee bracing. presented in the material do not necessarily represent the views of the AHA. You can use the Contents side panel to help navigate the various sections. There are no published clinical outcome studies of the S3 brace. Functional knee braces are fabricated from a variety of materials, including carbon composites, aluminum, and kevlar. not endorsed by the AHA or any of its affiliates. Brace application also caused a small increase in LT EMG during forward flexion and Y's and a small decrease in UT and MT EMG during shoulder extension. Orthosis is the singular noun for a custom-molded or pre-fabricated support. CPT codes, descriptions and other data only are copyright 2021 American Medical Association. Lindenfeld TN, Hewett TE, Andriacchi TP. Recommendations for the medical management of osteoarthritis of the hip and knee. THE UNITED STATES GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN An asterisk (*) indicates a required field. These materials contain Current Dental Terminology (CDTTM), copyright© 2021 American Dental Association (ADA). A52457 - Ankle-Foot/Knee-Ankle-Foot Orthoses - Policy Article, A55426 - Standard Documentation Requirements for All Claims Submitted to DME MACs, BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANY TYPE, FOOT PRESSURE OFF LOADING/SUPPORTIVE DEVICE, ANY TYPE, EACH, ANKLE FOOT ORTHOSIS, SPRING WIRE, DORSIFLEXION ASSIST CALF BAND, CUSTOM FABRICATED, ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF, ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, MULTILIGAMENTOUS ANKLE SUPPORT, PREFABRICATED, OFF-THE-SHELF, ANKLE ORTHOSIS, SUPRAMALLEOLAR WITH STRAPS, WITH OR WITHOUT INTERFACE/PADS, CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, POSTERIOR, SINGLE BAR, CLASP ATTACHMENT TO SHOE COUNTER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT WITH STATIC OR ADJUSTABLE STOP (PHELPS OR PERLSTEIN TYPE), CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, AFO, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, PLASTIC, RIGID ANTERIOR TIBIAL SECTION (FLOOR REACTION), CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), PLASTIC, CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ANKLE FOOT ORTHOSIS, POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP, CALF BAND/CUFF (SINGLE BAR 'BK' ORTHOSIS), CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP, CALF BAND/CUFF (DOUBLE BAR 'BK' ORTHOSIS), CUSTOM FABRICATED, KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE KNEE, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF BANDS/CUFFS (SINGLE BAR 'AK' ORTHOSIS), CUSTOM FABRICATED, 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, KNEE ANKLE FOOT DEVICE, ANY MATERIAL, SINGLE OR DOUBLE UPRIGHT, SWING AND STANCE PHASE MICROPROCESSOR CONTROL WITH ADJUSTABILITY, INCLUDES ALL COMPONENTS (E.G., SENSORS, BATTERIES, CHARGER), ANY TYPE ACTIVATION, WITH OR WITHOUT ANKLE JOINT(S), CUSTOM FABRICATED, KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF BANDS/CUFFS (SINGLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT, CUSTOM FABRICATED, KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF BANDS/CUFFS (DOUBLE BAR 'AK' ORTHOSIS), CUSTOM FABRICATED, KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND CALF BANDS/CUFFS, (DOUBLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT, CUSTOM FABRICATED, KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE MOTION KNEE, MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED, KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, STATIC (PEDIATRIC SIZE), WITHOUT FREE MOTION ANKLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, DOUBLE UPRIGHT, WITH OR WITHOUT FREE MOTION KNEE, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED, KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE MOTION KNEE, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED, KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, WITH OR WITHOUT FREE MOTION KNEE, MULTI-AXIS ANKLE, CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, THERMOPLASTIC TYPE CASTING MATERIAL, CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, CUSTOM FABRICATED, ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SOFT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI-RIGID, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, RIGID, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, THERMOPLASTIC TYPE CASTING MATERIAL, CUSTOM FABRICATED, KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, CUSTOM FABRICATED, KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SOFT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SEMI-RIGID, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, RIGID, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, PLASTIC SHOE INSERT WITH ANKLE JOINTS, ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, DROP LOCK KNEE JOINT, ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, LIMITED MOTION KNEE JOINT, ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, ADJUSTABLE MOTION KNEE JOINT, LERMAN TYPE, ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, QUADRILATERAL BRIM, ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, WAIST BELT, ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, HIP JOINT, PELVIC BAND, THIGH FLANGE, AND PELVIC BELT, ADDITION TO LOWER EXTREMITY, LIMITED ANKLE MOTION, EACH JOINT, ADDITION TO LOWER EXTREMITY, DORSIFLEXION ASSIST (PLANTAR FLEXION RESIST), EACH JOINT, ADDITION TO LOWER EXTREMITY, DORSIFLEXION AND PLANTAR FLEXION ASSIST/RESIST, EACH JOINT, ADDITION TO LOWER EXTREMITY, SPLIT FLAT CALIPER STIRRUPS AND PLATE ATTACHMENT, ADDITION TO LOWER EXTREMITY ORTHOSIS, ROCKER BOTTOM FOR TOTAL CONTACT ANKLE FOOT ORTHOSIS, FOR CUSTOM FABRICATED ORTHOSIS ONLY, ADDITION TO LOWER EXTREMITY, ROUND CALIPER AND PLATE ATTACHMENT, ADDITION TO LOWER EXTREMITY, FOOT PLATE, MOLDED TO PATIENT MODEL, STIRRUP ATTACHMENT, ADDITION TO LOWER EXTREMITY, REINFORCED SOLID STIRRUP (SCOTT-CRAIG TYPE), ADDITION TO LOWER EXTREMITY, LONG TONGUE STIRRUP, ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION ('T') STRAP, PADDED/LINED OR MALLEOLUS PAD, ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC MODIFICATION, PADDED/LINED, ADDITION TO LOWER EXTREMITY, MOLDED INNER BOOT, ADDITION TO LOWER EXTREMITY, ABDUCTION BAR (BILATERAL HIP INVOLVEMENT), JOINTED, ADJUSTABLE, ADDITION TO LOWER EXTREMITY, ABDUCTION BAR-STRAIGHT, ADDITION TO LOWER EXTREMITY, NON-MOLDED LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY, ADDITION TO LOWER EXTREMITY, LACER MOLDED TO PATIENT MODEL, FOR CUSTOM FABRICATED ORTHOSIS ONLY, ADDITION TO LOWER EXTREMITY, ANTERIOR SWING BAND, ADDITION TO LOWER EXTREMITY, PRE-TIBIAL SHELL, MOLDED TO PATIENT MODEL, ADDITION TO LOWER EXTREMITY, PROSTHETIC TYPE, (BK) SOCKET, MOLDED TO PATIENT MODEL, (USED FOR 'PTB' 'AFO' ORTHOSES), ADDITION TO LOWER EXTREMITY, EXTENDED STEEL SHANK, ADDITION TO LOWER EXTREMITY, PATTEN BOTTOM, ADDITION TO LOWER EXTREMITY, TORSION CONTROL, ANKLE JOINT AND HALF SOLID STIRRUP, ADDITION TO LOWER EXTREMITY, TORSION CONTROL, STRAIGHT KNEE JOINT, EACH JOINT, ADDITION TO LOWER EXTREMITY, STRAIGHT KNEE JOINT, HEAVY DUTY, EACH JOINT, ADDITION TO LOWER EXTREMITY, POLYCENTRIC KNEE JOINT, FOR CUSTOM FABRICATED KNEE ANKLE FOOT ORTHOSIS, EACH JOINT, ADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, EACH JOINT, ADDITION TO LOWER EXTREMITY, OFFSET KNEE JOINT, HEAVY DUTY, EACH JOINT, ADDITION TO LOWER EXTREMITY ORTHOSIS, SUSPENSION SLEEVE, ADDITION TO KNEE LOCK WITH INTEGRATED RELEASE MECHANISM (BAIL, CABLE, OR EQUAL), ANY MATERIAL, EACH JOINT, ADDITION TO KNEE JOINT, DISC OR DIAL LOCK FOR ADJUSTABLE KNEE FLEXION, EACH JOINT, ADDITION TO KNEE JOINT, RATCHET LOCK FOR ACTIVE AND PROGRESSIVE KNEE EXTENSION, EACH JOINT, ADDITION TO KNEE JOINT, LIFT LOOP FOR DROP LOCK RING, ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, GLUTEAL/ ISCHIAL WEIGHT BEARING, RING, ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM, MOLDED TO PATIENT MODEL, ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM, CUSTOM FITTED, ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW M-L BRIM MOLDED TO PATIENT MODEL, ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW M-L BRIM, CUSTOM FITTED, ADDITION TO LOWER EXTREMITY, THIGH-WEIGHT BEARING, LACER, NON-MOLDED, ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, LACER, MOLDED TO PATIENT MODEL, ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, HIGH ROLL CUFF, ADDITION TO LOWER EXTREMITY ORTHOSIS, PLATING CHROME OR NICKEL, PER BAR, ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRENGTH, LIGHTWEIGHT MATERIAL, ALL HYBRID LAMINATION/PREPREG COMPOSITE, PER SEGMENT, FOR CUSTOM FABRICATED ORTHOSIS ONLY, ADDITION TO LOWER EXTREMITY ORTHOSIS, EXTENSION, PER EXTENSION, PER BAR (FOR LINEAL ADJUSTMENT FOR GROWTH), ORTHOTIC SIDE BAR DISCONNECT DEVICE, PER BAR, ADDITION TO LOWER EXTREMITY ORTHOSIS, NON-CORROSIVE FINISH, PER BAR, ADDITION TO LOWER EXTREMITY ORTHOSIS, DROP LOCK RETAINER, EACH, ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, FULL KNEECAP, ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, KNEE CAP, MEDIAL OR LATERAL PULL, FOR USE WITH CUSTOM FABRICATED ORTHOSIS ONLY, ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, CONDYLAR PAD, ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, BELOW KNEE SECTION, ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, ABOVE KNEE SECTION, ADDITION TO LOWER EXTREMITY ORTHOSIS, TIBIAL LENGTH SOCK, FRACTURE OR EQUAL, EACH, ADDITION TO LOWER EXTREMITY ORTHOSIS, FEMORAL LENGTH SOCK, FRACTURE OR EQUAL, EACH, LOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED, REPLACEMENT STRAP, ANY ORTHOSIS, INCLUDES ALL COMPONENTS, ANY LENGTH, ANY TYPE, REPLACE QUADRILATERAL SOCKET BRIM, MOLDED TO PATIENT MODEL, REPLACE QUADRILATERAL SOCKET BRIM, CUSTOM FITTED, REPLACE MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY, REPLACE NON-MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY, REPLACE MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY, REPLACE NON-MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY, REPLACE PROXIMAL AND DISTAL UPRIGHT FOR KAFO, REPLACE METAL BANDS KAFO-AFO, CALF OR DISTAL THIGH, REPLACE LEATHER CUFF KAFO, PROXIMAL THIGH, REPLACE LEATHER CUFF KAFO-AFO, CALF OR DISTAL THIGH, REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES, REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS, ANKLE CONTROL ORTHOSIS, STIRRUP STYLE, RIGID, INCLUDES ANY TYPE INTERFACE (E.G., PNEUMATIC, GEL), PREFABRICATED, OFF-THE-SHELF, WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE, WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED, OFF-THE-SHELF, PNEUMATIC FULL LEG SPLINT, PREFABRICATED, OFF-THE-SHELF, WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE, WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED, OFF-THE-SHELF, REPLACEMENT, SOFT INTERFACE MATERIAL, STATIC AFO, REPLACE SOFT INTERFACE MATERIAL, FOOT DROP SPLINT, STATIC OR DYNAMIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL, ADJUSTABLE FOR FIT, FOR POSITIONING, MAY BE USED FOR MINIMAL AMBULATION, PREFABRICATED ITEM THAT HAS BEEN 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