Last updated on 4/11/18 | First published on 11/18/17 | Literature review current through Nov. 2024
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CODING, COVERAGE AND REIMBURSEMENT
General
LCD: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33686&ContrID=140
Policy Article: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52457&ContrID=140
Walking boots
- HCPCS:
- Coverage requirements:
- Frequency of replacement allowed by Medicare:
-
- Non-covered conditions:
A foot pressure off-loading/supportive device (A9283) is denied as noncovered (no Medicare benefit), because it does not support a weak or deformed body member or restrict or eliminate motion in a diseased or injured part of the body.
Static/dynamic Ankle-Foot Orthosis
- HCPCS:
- L4396 or L4397 is covered, a replacement interface (L4392)
- Coverage requirements:
- Frequency of replacement allowed by Medicare:
- If code L4396 or L4397 is covered, a replacement interface (L4392) is covered as long as the beneficiary continues to meet indications and other coverage rules for the splint. Coverage of a replacement interface is limited to a maximum of one (1) per 6 months. Additional interfaces will be denied as not reasonable and necessary.
- Non-covered conditions:
- A static/dynamic Ankle-Foot Orthosis (AFO) (L4396, L4397) and replacement interface (L4392) are denied as noncovered (no Medicare benefit) when they are used solely for the prevention or treatment of a heel pressure ulcer because for these indications they are not used to support a weak or deformed body member or to restrict or eliminate motion in a diseased or injured part of the body (i.e., it does not meet the definition of a brace).
- Billing reminders:
Foot drop splint/ recumbent positioning device
- Medicare does not reimburse for a foot drop splint/recumbent positioning device (L4398) or replacement interface (L4394)
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CODING, COVERAGE AND REIMBURSEMENT
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CODING, COVERAGE AND REIMBURSEMENT
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