CORRECT CODING – ANKLE ORTHOSES, WITH OR WITHOUT JOINTS, PREFABRICATED OR CUSTOM FABRICATED CODING VERIFICATION REVIEW
Joint DME MAC Publication
The Centers for Medicare & Medicaid Services HCPCS Workgroup released HCPCS codes effective January 1, 2016. Ankle orthosis codes L1902 and L1904 are revised to include reference to joints. The revised codes read:
L1902 - ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF
L1904 - ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, CUSTOM FABRICATED
Ankle orthoses (ankle gauntlet or similar) with joints historically have been listed on DMECS as L2999 (LOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED). All ankle gauntlets or similar orthoses with joints listed on DMECS as L2999 will be end dated effective June 30, 2016. All manufacturers must submit a new coding verification review application to the Pricing Data Analysis and Coding Contractor (PDAC) to reclassify those products currently listed as L2999.
The PDAC coding verification application required is the Orthotics application. This application is located on the PDAC website, https://www.dmepdac.com/review/apps_check.html.
For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.
The Ankle-Foot/Knee-Ankle-Foot Orthosis LCD will be updated with these code narrative revisions at a future date.
Published by Noridian as the PDAC, December 2015. Republished by Palmetto GBA as the PDAC, February 2019. Please note that links in this document were accurate at the time of original publication and may change over time and are no longer active.