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Charcot Restraint Orthotic Walker Coding Update

A new HCPCS code been established for the CROW Boot, effective for claims with dates of service on or after 1/1/2011.

L4631 - Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated

The information in this coding article supersedes and replaces instructions in the previous coding article for the Charcot Restraint Orthotic Walker published by the PDAC on 8/19/2009. The Charcot Restraint Orthotic Walker, also referred to as CROW boot or walker, was developed for patients with severe deformity of the foot and ankle due to a sensory neuropathic arthropathy, most commonly caused by diabetes. The device is a bi-valved copolymer full foot enclosure, totally encapsulated around the ankle and foot with a rocker bottom sole built into the device. The orthosis is custom fabricated to a positive model made from an impression of the patient's affected limb. It is fully lined and uses a custom foot insert. Appropriate modifications are performed to the impression, which permits for equal weight distribution through the limb and provides support of the ankle joint, tibia, and fibula. The CROW boot can be modified to accommodate changes by flaring, adding padding, and trimming where and when appropriate.

No other codes may be billed for a CROW boot. There is no separate billing for any modifications, fitting, or adjustments.

When these products are used solely to treat edema or ulcers, or to prevent an ulcer of the lower extremity, suppliers should code them based on the patient’s condition. HCPCS code A9283 (Foot pressure off loading/ supportive device, any type, each) was developed to describe various devices used for the treatment of edema or for a lower extremity ulcer or for the prevention of ulcers. If the CROW boot is used for these conditions and the patient does not have Charcot arthropathy, then it should be coded A9283.

The PDAC coding verification application required for these products is the Orthotics application. This application is located on the PDAC website.

For questions about correct coding, please 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 email the PDAC by completing the DME PDAC Contact Form located on the PDAC website.

Reference: Pricing, Data Analysis, and Coding Contractor

Charcot Restraint Orthotic Walker Coding Update
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