ReimbursementNews
Ankle-Foot Orthoses – Arizona-Type – Correct Coding – REVISED
Arizona AFO is a company that manufactures a line of custom fabricated ankle-foot orthoses . Other companies manufacture similar products . The Pricing , Data Analysis and Coding ( PDAC ) contractor has recently reviewed the Arizona AFO line of products and determined the appropriate HCPCS codes to be used when billing for these and similar items .
For the Arizona Short and Arizona Tall , or similar custom fabricated braces , only the following codes should be used :
• L1940 Ankle foot orthosis , plastic or other material , custom fabricated
• L2330 Addition to lower extremity , lacer molded to patient model , for custom fabricated orthosis only
• L2820 Addition to lower extremity orthosis , soft interface for molded plastic below knee section
• L2330 is used whether the closure is a lacer closure or a Velcro closure .
• L2820 is used only if a soft interface ,
Mark Your Calendars IVO Congress 2012
March 29-31 , 2012 Sydney , Australia either leather or other material , is provided .
This section has been revised from the original article , titled Ankle-Foot Orthoses – Arizona Type – Correct Coding , posted on Dec . 4 , 2008 . The Durable Medical Equipment Coding System ( DMECS ) has been updated to reflect any applicable changes .
For the Arizona Extended and the Arizona Unweighting or similar custom fabricated braces , only the following codes should be used :
• L1960 Ankle foot orthosis , posterior solid ankle , plastic , custom-fabricated
• L2330 Addition to lower extremity , lacer molded to patient model , for custom fabricated orthosis only
• L2820 Addition to lower extremity orthosis , soft interface for molded plastic below knee section
The following codes must not be used for these orthoses :
• L2275 Addition to lower extremity , varus / valgus correction , plastic modification , padded / lined
• L2280 Addition to lower extremity , molded inner boot
For the Arizona Partial Foot model or similar orthosis , use codes :
• L1940 Ankle foot orthosis , plastic or other material , custom-fabricated
• L2330 Addition to lower extremity , lacer molded to patient model , for custom fabricated orthosis only
• L2820 Addition to lower extremity orthosis , soft interface for molded plastic below knee section
• L5000 Partial foot , shoe insert with longitudinal arch , toe filler
Suppliers , manufacturers and distributors are reminded to check the product listing on the Product Classification List located on DMECS . If there are any changes , they are to notify the PDAC .
Coding Guidelines for Ankle Foot Orthoses
The Durable Medical Equipment Medicare Administrative Contractors ( DME MACs ) and the Pricing , Data Analysis and Coding ( PDAC ) contractor recently received questions regarding coding guidelines for Ankle Foot Orthoses . In an effort to address these questions , the following definitions for certain orthoses will clarify their meaning and assist suppliers in correct coding of these devices .
L2340 Addition to Lower Extremity , Pre-Tibial Shell , Molded to Patient Model A pre-tibial shell , custom fabricated , provides a rigid overlapping interlocking anterior tibial control between the tibial tuberosity to a point no greater than 3 inches proximal to the medial malleolus . The pre-tibial shell can be constructed from thermosetting materials , thermoplastics or composite type materials .
L1906 Ankle Foot Orthosis , Multiligamentous Ankle Support , Prefabricated , Includes Fitting and Adjustment A multiligamentous ankle support provides control of the ankle joint between the medial and lateral malleoli while allowing for dorsiflexion and plantar flexion . This off-the-shelf ankle support includes a rigid stirrup and foot plate , which provides functional tracking of the ankle with hind-foot and mid-foot stability during ambulation . This , in conjunction with wraparound straps and the inherent gauntlet design , offers areas of multiligamentous support as described by the code . There are no additional HCPCS codes for this type of prefabricated ankle orthosis .
L1960 Ankle Foot Orthosis , Posterior Solid Ankle , Plastic , Custom-Fabricated An Ankle Foot Orthosis ( AFO ) provides ankle control for patients with
36 Pedorthic Footcare Association www . pedorthics . org