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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 1/1/2016. 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 6/30/2016. All manufacturers must submit a new coding verification review application to the 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.

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 email the PDAC by completing the DME PDAC Contact Form located on the PDAC website.

The ankle-foot/knee-ankle-foot orthosis LCD will be updated with these code narrative revisions at a future date.

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Posted 12/3/2015

Correct Coding - Ankle Orthoses, With or Without Joints, Prefabricated or Custom Fabricated Coding Verification Review
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