Effective for dates of service on or after January 1, 2004, a new HCPCS code has been established for a knee orthosis:
L1831 Knee orthosis, locking joint(s), positional orthosis, prefabricated, includes fitting and adjustment.
This HCPCS code describes a knee orthosis which has double uprights and a locking joint for positioning the knee. This joint locks the knee into a particular position either in flexion or extension. This orthosis is designed for a patient who is nonambulatory. It is typically used to treat a flexion contracture of the knee. It is important to distinguish this HCPCS code from two other existing HCPCS codes for knee orthoses, L1832 and L1845.
HCPCS code L1832 describes a prefabricated knee orthosis that has double uprights and adjustable flexion and extension joints. An adjustable flexion and extension joint is one which enables the practitioner to set limits on flexion and extension but allows the patient free motion of the knee within those limits. The joints can be unicentric or polycentric. Medial-lateral control of the knee is accomplished by way of the solid metal (or similar material) structure of the double uprights. It may have condylar pads. This orthosis is designed for a patient who can bear weight on the knee and is capable of some ambulation. It is typically used for early rehabilitation following knee surgery.
HCPCS code L1845 describes a prefabricated knee orthosis that has double uprights, condylar pads, and an adjustable flexion and extension joint (as described above) and provides both medial-lateral and rotation control. The joint can be unicentric or polycentric. The function of the joint is to control flexion and extension of the knee joint. Medial-lateral control of the knee is accomplished by the solid metal (or similar material) structure of the double uprights. Rotation control is accomplished by the combination of (1) solid metal (or similar material) in the anterior portion of the thigh and calf cuffs and (2) the condylar pads. Rotation of the knee joint occurs during weight bearing and ambulation. This orthosis is designed for a patient who is fully ambulatory.
Published by Palmetto GBA as the SADMERC, December 4, 2003. Republished by Noridian as the PDAC, August 2008. Republished by Palmetto as the PDAC, January 2019.