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Concentric Adjustable Torsion Joints – Correct Coding

Based on a benefit category determination from the CMS, the DME MACs are revising the KO and AFO/KAFO) orthosis policy articles. The revision includes information about the proper coding of concentric adjustable torsion-style mechanisms incorporated into orthotics.

The distinction in coding relates to the indicated use of the joint and the beneficiary’s medical condition(s). Concentric adjustable torsion-style joints used solely to provide an assistive function for joint motion must be coded L2999 or L3999. When concentric adjustable torsion-style joints are used for any condition other than to provide an assistive function for joint motion, they must be coded as durable medical equipment using the following codes:

  • E1800 Dynamic adjustable elbow extension/flexion device
  • E1802 Dynamic adjustable forearm pronation/supination device
  • E1805 Dynamic adjustable wrist extension/flexion device
  • E1810 Dynamic adjustable knee extension/flexion device
  • E1815 Dynamic adjustable ankle extension/flexion device

The effective date of the LCD and related policy article revision for the concentric adjustable torsion-style mechanisms will be for claims with dates of service on or after 3/13/2012. The remainder of the LCD and related policy article revisions will be effective for dates of service on or after 7/1/2012.

Suppliers of these products are strongly encouraged to read the AFO/KAFO and KO LCDs and related PAs for additional information on coverage, coding and documentation.

Concentric Adjustable Torsion Joints – Correct Coding
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